by
Nancy Ryerson, Staff Writer | June 17, 2013
From the June 2013 issue of HealthCare Business News magazine
One of those areas that may be affected is prostate cancer diagnosis and tracking. In March, CMS proposed limiting reimbursement for FDG PET scans for prostate cancer patients. The same decision also limited reimbursement to one scan per patient.
While FDG PET scans have been found to be less useful for the early stages of prostate cancer, they are helpful when evaluating treatment response to metastatic prostate cancer, according to a study published in 2012 in the American Journal of Roentgenology.
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“Prostate cancer is heterogeneous, so it’s hard to follow what’s happening with the disease at different times,” says Hossein Jadvar, study author and president of the American College of Nuclear Medicine. “PET imaging can be helpful to stratify patients and do the right thing to the right person at the right time.”
Jadvar and the American College of Nuclear Medicine composed a multiple society letter to CMS encouraging FDG PET reimbursement for prostate cancer.
“We thanked them for reimbursing some, but said that just one scan isn’t enough,” says Jadvar. “And FDG PET does hold value.”
Besides FDG, sodium fluoride has also experienced resurgence as a tracer in bone scanning for metastatic prostate cancer. Such scans can reveal cancers that CT scans miss.
One newly approved imaging agent for prostate cancer treatment is C-11 choline, a tracer developed at the Mayo Clinic that was approved by the FDA in September 2012.
“It’s used for patients who have already been treated for prostate cancer, but tests show that it’s coming back,” says Dr. Timothy DeGrado, president of SNMMI’s Radiopharmaceutical Sciences Council. “A C-11 PET scan has shown to be useful in detecting where that recurrent prostate cancer is.”
In the skin and breast cancer space, Tc 99m (Lymphoseek) recently became the first drug approved for lymph node mapping since 1981. It allows doctors to see if cancer has spread to the lymph nodes and helps them pinpoint and remove the diseased tissue.
Flurpiridaz F 18 is a PET imaging agent being developed by Lantheus that the company says will be used to evaluate cardiac blood flow in patients with known or suspected coronary artery disease. It’s currently in Phase 3 clinical trials.
Another F 18-based isotope, LMI 1195, helps identify candidates for an implantable cardioverter defibrillator to decrease the risk of sudden cardiac death.
"People get them who don't need them, and there are people who need one who don't fit into the categories to get them," says William Dawes, vice president, Manufacturing and Supply Chain of Lantheus Medical Imaging. "There is currently no good test to risk-stratify. LMI 1195 is a novel F 18 small molecule tracer that has the potential to help decrease risk of sudden cardiac death."
