For most patients, the PET/CT scan takes about two hours to complete, depending on whether the whole body, or a particular part of the body is scanned.
On the day of the test, patients should bring:
- All previous studies, including CT and/or MR films and reports.
- Any prior PET or PET/CT images and reports if one was performed at some other time or site.
- Their chemotherapy history, including date of most recent treatment.
- Insurance information.
Restrictions and Preparing for the Test:
- Patients should not eat or drink (other than water) 6 hours prior to the exam.
- Patients are encouraged to drink plenty of water prior to the exam.
- Patients should refrain from strenuous excise for 2 days prior to the exam.
- Diabetic patients require special preparation and should call the PET/CT Center for instructions
As reflected in the proposed decision memorandum (PDM), CMS found little evidence about effects of FDG PET on outcomes for patients whose initial therapy for prostate cancer had been completed. Current literature on PET tracers for recurrence or tumor response seemed to focus mainly on a different radiopharmaceutical, 11C choline.
However, public comments about the PDM indicated that evidence of the value of FDG PET scans was in some cases provided in therapeutic studies and was also available in more recent articles. After review of these important components of the evidence base, CMS agrees that a significant benefit of FDG PET scans is their use to determine effect of treatment, especially at certain types of progressive prostate disease.
As examples of the importance of this, NOPR findings (e.g., Hillner 2012) indicate that in about 40% of instances, physicians would change their intended therapy for patients with prostate cancer. Despite the known concerns about lack of glucose avidity of prostate cancer cells, as mentioned in Hillner 2009 other studies indicated that FDG PET CT could be valuable even for assessing activity of bone metastases of prostate cancers in a large majority of patients (Meirelles 2010).
Nevertheless, we are convinced that FDG PET/CT imaging’s selective use in assessing progression of prostate cancer does provide valuable additional information for managing treatment decisions, and therefore we consider its use for subsequent treatment strategy planning to be reasonable and necessary. We note that in many of these studies, a rising PSA level was key to the clinical suspicion of progressive or recurrent prostate cancer.
We also agree with the NOPR public comments emphasizing that physicians were found to selectively employ FDG PET for subsequent anticancer treatment planning in appropriate patients. We expect that post-coverage analysis (PCA) review by CMS will confirm this NOPR observation.
Consequently, CMS proposes that use of FDG PET/CT when used to guide subsequent anti-tumor treatment strategy for patients with cancer of the prostate is reasonable and necessary under § 1862(a)(1)(A).