Good detective stories may have crossed your early path in life. Perhaps you read vintage classics like the classic Nancy Drew or Hardy Boys books, or more recently Nate the Great and Encyclopedia Brown. If you got hooked, you advanced to classic tales about Sherlock Holmes, Miss Marple and others. Our TVs brought Sgt. Columbo into our living rooms, and the Sunday Comics featured Dick Tracy. If you found mysteries entertaining, you had plenty of choices.

On the other hand, there’s nothing entertaining about prostate cancer (PCa). Being told you have it is not fiction, but a harsh reality. However, when detected and diagnosed early while it’s still confined to the gland softens the blow. That is when it’s most treatable, with post-treatment 5-year survival rates greater than 99% for low-risk, localized disease.

Unfortunately, not all cases are diagnosed early, and not all PCa cell lines are of equally low risk. In fact, roughly 15% of cell lines are aggressive, usually due to dangerous mutations in a patient’s genes. Such patients face a more complicated threat, since this type of PCa is sneaky. With little warning or few symptoms, these cell lines are more likely to have breakaway tumor cells that can rapidly begin microscopic spread beyond the gland. Some are silent killers that do not even cause PSA to rise.

Thankfully, certain analytic tests on blood samples or a biopsy tissue can identify initial clues like circulating tumor cells or genomic variants—but now the mystery begins. Have the cells begun to spread? If so, where are they?

These are vital problems to solve because they determine the best treatment plan. Now the patient’s doctor becomes a detective. Just as the technologies used by fictional—and real—detectives have progressed from magnifying glass to dusting for fingerprints to security cameras and DNA crime labs, the tools available to medical detectives have also evolved. To identify the location and extent of a PCa tumor and its potential spread, we’ve gone from PSA blood test, biopsy, and even exploratory surgery to noninvasive imaging tools that might once have been considered science fiction.

The latest and greatest PCa imaging resource is called PSMA PET/MRI. This type of scan, which relies on injecting an agent that binds with PCa cells and “lights up” during the scan, was initially designed for CT (computed tomography) scanning. More recently, however, integrating PSMA PET with MRI has shown to have comparable or even better detection rates, plus the advantage of anatomical and radiomics features not available with CT^[i].

Equipped with PSMA PET/MRI imaging technology, an experienced radiologist, like an expert detective, can now expose cancerous culprits lurking in the prostate gland, pelvic bed, lymph nodes, and remote areas—even at an incredibly small size! Given how far we’ve come since the mid-1990s when the PSA blood test became available, we’ve accomplished a revolution in imaging technology. While there will undoubtedly be new wonders in the future, PSMA PET/MRI is the greatest prostate cancer detection story yet.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Morton, Will. “PET/CT and PET/MRI appear equivalent for diagnosing prostate cancer.” Aunt Minnie/Clinical News/Molecular Imaging, Aug. 31, 2023. https://www.auntminnie.com/clinical-news/molecular imaging/article/15634138/petct-and-petmri-appear-equivalent-for-diagnosing-prostate-cancer