Blood tests consisting of PAP, CEA, LDH, plasma chromogranin A, and neuron specific enolase and PSA are ordered to ascertain metastatic tumor burden. The presence of neuroendocrine components in prostate cancer may cause the above tests to be elevated, suggesting metastatic disease. Pathology slides are reviewed and evaluated for specific oncogenetic proteins.

Preoperative Prostascint evaluation is indicated to rule in or rule out the presence of metastatic deposits outside the prostate and in the pelvic and/or para-aortic lymph nodes. If this test is, in fact, positive, then further therapies would be added to the seed implant therapy, such as hormone therapy and/or external beam radiotherapy. Elimination of external beam radiation therapy in this setting may reduce the chance of rectal complications.

An equally important reason for Prostascint evaluation is preparation for image guided brachytherapy. Fusing the Prostascint image onto preoperative MR/CT images utilizing specific image fusion software will create an anatomic map of the prostate with the malignant deposits delineated. This map can be transposed into the real time ultrasound image in the operating room with the resultant ability to increase radiation seed dose to the areas of antibody uptake and a decrease of dose to the areas free of antibody uptake. The use of intraoperative treatment planning as Dr. Doggett is currently doing facilitates the planning in the operating room, increasing dose to malignant structures and decreasing dose to nonmalignant structures, such as the rectum, urethra, bladder and neurovascular bundles.

Dr. Doggett works closely with highly respected nuclear medicine physicians in northern and southern California for the production and integration of prostascint fusion scans.