In our book, Invasion of the Prostate Snatchers, Ralph Blum and I devoted a chapter to the heartbreaking story of how Combidex, a revolutionary way to detect cancerous lymph nodes, was shot down by the FDA. Detecting cancer in the lymph nodes is the Holy Grail of cancer scanning because the lymph nodes are the first place prostate cancer usually spreads if it leaves the prostate. Standard CT scans fail to detect cancer until the tumorous nodes are bulging with cancer.
The early detection of lymph node metastases
has become a much higher priority now that lymph nodes can be safely targeted
with modern radiation. In the past, with
older radiation, side effects were excessive due to collateral damage to the
intestines.
At Prostate Oncology Specialists we have had
reasonably good results imaging lymph nodes with C11 acetate PET
scans performed by Dr. Fabio Almeida in Phoenix. Also, Choline PET scans have been used with
success at the Mayo Clinic. However, even with PET scans there needs to be minimum
amount of tracer present in the lymph node before it reaches the threshold of
detectability. Therefore, PET scans may be unable to detect metastatic nodes
until the cancerous nodules are more than 6 mm in diameter. Studies evaluating intravenous Combidex in
conjunction with MRI scanning indicate that normal lymph nodes can be
distinguished from metastatic nodes even when the metastases are as small as 3
mm. In one study comparing Combidex with Choline
PET scans, Combidex was more accurate at detecting metastatic nodes.
I am raising the matter of Combidex in this
blog because now, for the first time in years, Combidex has become commercially
available again in Europe. Dr. Jelle Barentsz from the University in Nijmegen has been able to purchase all rights
to Combidex along with all the documents and files from the original manufacturer.
Unfortunately, as yet there are no sites in the United States that offer
Combidex.
More than 50,000 men annually develop a
cancer relapse after surgery or radiation.
A relapse is indicated by the presence of a rising PSA level in the
blood. The rising PSA signals that cancer is present, but offers no indication
about the location of the cancer in
the body. New scans such as C11 PET and Combidex-enhanced MRI have opened
up a whole new realm of treatment possibilities. After all, if the cancer can
be located, it creates a possibly for cure by targeting it with radiation.
We welcome the renewed availability of
Combidex, thanks to the concerted efforts of Dr. Barentsz.
READ MORE ON COMBIDEX
Past Blogs by Ralph Blum
http://prostatesnatchers.blogspot.com/2012/11/life-after-combidex-part-1.html
http://prostatesnatchers.blogspot.com/2012/11/life-after-combidex-part-2.html
http://prostatesnatchers.blogspot.com/2012/12/blog-post.html
Latest PCRI Insights written by Jelle Barentsz, MD
http://prostate-cancer.org/detecting-lymph-node-metastases-combidex/
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