PSMA PET CT Imaging

PSMA PET CT Prep

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Medically reviewed by Dr. Alex Tamm, BMSc, MD (STIR), FRCPC

What is a PSMA PET CT scan?

A PSMA PET CT scan is an advanced form of hybrid diagnostic imaging that uses a prostate-specific membrane antigen (PSMA) to localize cancer lesions in prostate cancer. Prostate cancer is the fourth most common cancer in Canada and represents the number one most common cancer in men (Government of Canada, 2021). PSMA PET CT imaging is state-of-the-art and is changing how prostate cancer is detected and, ultimately, treated in patients across Alberta.

How does a PSMA PET CT work?

PSMA is a protein located on the surface of prostate tissue cells that is overexpressed in prostate cancer cells. During a PSMA PET CT scan, we inject a radiotracer that targets the specific protein.

The PET scanner detects where the radiotracer concentrates to demonstrate where prostate cancer cells are located in the body.

The degree of uptake has been shown to correlate with the aggressivity of the tumour on pathology. Information from PSMA PET CT scans can impact treatment decisions at almost all stages.

More specifically, PSMA PET CT can help diagnose prostate cancer initially, identify cancer that has come back after treatment, or localize cancer that has spread to other parts of the body. It can also be used as a troubleshooting tool in the setting of other equivocal testing.

PSMA PET CT imaging is a hybrid scan, meaning the single machine can simultaneously capture cross-sectional images of the body from CT and cellular structure from PET during a single visit. Combining the two tests can save time and increase accuracy compared to performing these tests separately.

How does PSMA PET CT compare to conventional staging exams with MRI or CT?

PSMA PET CT is considered a valuable tool in the clinical management of prostate cancer. It is the single most sensitive imaging test available to assess prostate cancer (Society of Nuclear Medicine and Molecular Imaging, 2021).

It has shown promising results in the initial staging of prostate cancer, identification of recurrent or persistent disease, and assessment of metastatic disease at different stages. PSMA imaging has been shown to impact treatment decisions and occasionally open new potential treatment options for patients.

If PSMA PET CT is so new, why should I choose MIC for my scan?

MIC’s radiologists have clinical experience reading these specialized diagnostic imaging scans. Our team of dual-certified radiologists (Diagnostic Radiology & Nuclear Medicine) are the same physicians who report PSMA PET CT studies at the University of Alberta and Royal Alexandra Hospitals.

Our physicians were part of the original trials bringing PSMA PET CT to Alberta at the University of Alberta Hospital and multiple subsequent trials at both the Royal Alexandra and University of Alberta hospitals.

They bring that same expertise to the imaging services at MIC Medical Imaging. One of MIC’s radiologists – Dr. Jonathan Abele, was part of the original clinical collaboration that scanned the first patient in Alberta in August 2021!

What to Expect During a PSMA PET CT Scan

You may be asked to change into a gown when you arrive for your exam.
One of our technologists starts an intravenous (IV) line to inject the medications and/or radiotracer.
- You will have to wait for a short time in a private uptake room to allow the radiotracer to circulate through your body.
- You may need to get an IV injection of contrast dye or a medication to help you clear the radiotracer from the bladder.
The PET CT scanner is a large machine shaped like a doughnut – like a CT or MRI machine. You will lie on an exam table that slides into the doughnut opening. During the scan, you must remain still, as movement can make the scan images blurry.
The time for a PET CT scan varies depending on the type of exam, ranging between approximately 15 to 45 minutes. On average, the entire PET CT appointment can last around 2-3 hours in total.

How Much Does a PSMA PET CT Scan Cost?

MIC uses PSMA PET CT imaging in cancer (oncology) imaging. Currently, PSMA PET CT imaging used in oncology applications is not covered by the Alberta Health Care Insurance Plan (AHCIP) when performed in a community-based clinic outside the hospital. While Health Canada approved the first PSMA radiopharmaceutical in October 2022, routine use of PSMA-PET has not been established in Canada, and access is mainly through clinical trials, private healthcare, and registries.

The cost of a PSMA PET CT scan for a cancer application at MIC is as follows:

PET CT Imaging Exam	Cost
PSMA PET CT	$3,299.00
Diagnostic Enhanced CT Scan	$499.00

Please note:

Our dual-trained radiologist and nuclear medicine physicians will protocol all requisitions to ensure an accurate price estimate.
The price is based on the need for a combined diagnostic enhanced CT.
If a combined PET and diagnostic enhanced CT is required, the CT component will be $499.

Patients are encouraged to talk to their employer or a Benefits Specialist before booking their exam to see if they qualify for extended coverage. Some extended benefits programs or health spending accounts may cover a portion or possibly the entire exam fee.

What if I Live Outside of Edmonton and Want to Book a PET CT?

MIC is proud to be the first provider in Alberta and only the second in Western Canada to offer PET CT imaging in a community-based clinic environment. Since there are so few scanners outside of the hospital environment across the country, patients may consider travelling to Edmonton for their imaging needs. Our booking team is happy to review healthcare coverage, provide accurate price quotes and schedule exams.

Hotel Partnerships

We are also happy to help travelling patients take advantage of price discounts with two local hotels!

Patients flying into Edmonton should consider taking advantage of our partnership with the Renaissance Edmonton Airport Hotel.

Patients driving into Edmonton may prefer to stay at the Delta Hotels Edmonton South Conference Centre, which is conveniently located near our Century Park clinic, where PET CT imaging is offered.

Be sure to ask our booking team for detailed instructions on how to save money if you are considering travelling for your PET CT exam.

PSMA PET CT FAQs

What are the other PSMA agents used in PSMA PET CT imaging?

At MIC, we use a Health Canada-approved radiotracer, 68-Gallium PSMA-11. Other commonly used radiotracers available through clinical trials are 18F PSMA compounds.

Is PSMA specific to the prostate gland and prostate cancer cells?

No. Although there is a high expression of this protein on prostate tissue and prostate cancer cells, the protein can be found in low amounts in other organ tissues. The uptake pattern plays an important role in interpreting your PSMA PET CT exam.

Can PSMA PET CT confirm I don't have cancer?

Although there is no diagnostic imaging test that can provide 100% confirmation of metastatic cancer, PSMA PET CT appears to be the most sensitive and accurate test currently available for identifying metastatic sites of disease in prostate cancer.

Do I have to fast before my PSMA PET CT scan?

Patients must not eat or drink anything except plain water for a minimum of 4 hours before the appointment.

Patient preparation instructions vary depending on the type of PET CT exam performed. Our booking team will provide detailed instructions when you schedule your exam. It is important to follow the preparation instructions closely, as improper preparation can affect the scan’s results or cause the scan to be rescheduled.

If you have any questions or concerns about your preparation, our booking team is happy to help. When you schedule your appointment, our team will review specific exam preparation instructions based on your PET CT study.

Do any medications interfere with my PSMA scan?

No. You should be able to continue your normal medications with unchanged doses.

What is theranostics? Is PSMA a theranostic agent?

Theranostics (therapeutics + diagnostics = theranostics) is a two-pronged approach to diagnosing and treating cancers through the use of radiotracers.

PSMA is an example of a theranostic agent. If the radioactive component is switched to a therapeutic one (i.e. 68Ga/18F is switched to 177Lu/225Ac), it can specifically target and treat the cancer cells. Before a therapeutic radiotracer is used, patients generally must have a diagnostic scan first, to confirm and assess the ability to target the tumor cells.

Why am I scheduled for two PET scans?

Occasionally, to help with treatment decision-making, your physician may request both PSMA and FDG PET CT scans to help characterize the tumours or metastases. The PSMA PET scan shows how many tumour cells still have the PSMA receptors, while the FDG PET scan shows how metabolically active the cells are.

Each of these PET scans provides complementary information to aid the clinician in making the optimal personalized treatment decision for each individual.

View References

Alberta Cancer Foundation. (2024). Better Prostate Cancer Outcomes with the PSMA PET. https://albertacancer.ca/blog/bettering-prostate-cancer-outcomes-with-the-psma-pet/

Government of Canada. (2021, March). Prostate cancer in Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/prostate-cancer.html

Government of Canada Drug and Health Product Portal. (2024). Regulatory Decision Summary for Illuccix.® https://dhpp.hpfb-dgpsa.ca/review-documents/resource/RDS01017

My Leap Magazine. (2023). New Technology: Taking Prostate Cancer Imaging to the Next Level. https://myleapmagazine.ca/2023/03/27/new-technology-prostate-imaging-psma-pet/#:~:text=The%20first%20patient%20in%20Alberta,received%20a%20PSMA%2DPET%20scan

Society of Nuclear Medicine and Molecular Imaging. (2021). Prostate-Specific Membrane Antigen (PSMA) PET Scan. https://www.snmmi.org/Patients/Procedures/Content.aspx?ItemNumber=13981

Telix Pharmaceuticals Limited. (2022, October). Health Canada Approves Illuccix® for Prostate Cancer Imaging. https://www.newswire.ca/news-releases/health-canada-approves-illuccix-r-for-prostate-cancer-imaging-897279655.html

Learn more about PET CT imaging at MIC:

PET CT Imaging

FDG PET CT Imaging

DOTATATE PET CT Imaging

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