Patient Facing Nuclear Medicine

The field of nuclear medicine has seen a resurgence in relevance especially in the area of prostate cancer imaging and therapy.  Dr. Evan Yu adeptly summarizes the promising potential of PSMA radioligand therapies in his October 2018 post in the Clinical Trials section of UroToday.  We look forward to seeing his future article regarding diagnostic trials evaluating various PSMA targeted agents.

These new technologies have presented an interesting challenge for nuclear medicine physicians and radiologists across the world.  As specialists known for hiding out in dark rooms in solitude, are we ready to step into the light and see patients in the clinic? Or will we continue to hide from any human interaction and just perform the work that is put in front of us?  Are we ready to present the imaging at tumor boards and then also have informed discussions with our urology, oncology, and radiation oncology colleagues regarding the best treatment choices for our patients with advanced prostate cancer?  

In 2014, soon after the FDA approval of radium 223 in 2013, a colleague and I published an editorial outlining the importance of radiopharmaceutical therapies and the opportunity to be a more active participant in patient facing longitudinal clinical care1.  This was in response to our patients visiting the oncologist before each dose of radium 223 because there was a lack of confidence in nuclear medicine’s ability to manage patients during therapy.  This struck me as an overutilization of a limited and valuable resource, the oncologist’s time, but it was a wakeup call that we could do better.  Sadly, in 2018, I don’t think much has changed. 

Fortunately, we will be given another opportunity to seize the day as new nuclear medicine therapies enter the clinical space.  Novartis’ $3.9 billion purchase of Advanced Accelerator Applications (AAA) in 2017 and $2.1 billion purchase of Endocyte in October 2018 are clear signals that radioligand and targeted radiotherapies will be key components of future cancer therapeutics.  Patient friendly clinics and nuclear medicine consult services will be key pieces for our specialty to add value to the patient care journey.  The future must also include more meaningful participation in clinical trials by radiology and nuclear medicine experts especially as radiomics develops.  

The time has come to develop disease site experts within the fields of nuclear medicine and nuclear radiology which not only adds value, but also prevents commoditization of a critical clinical service.  I respectfully ask that our oncology, urology, and radiation oncology colleagues welcome their nuclear medicine counterparts to the patient facing side of clinical care.

Written by: Phillip Koo, MD

Reference:

1. Koo PJ, Bagrosky BM. Nuclear medicine therapy clinics: a golden opportunity for direct longitudinal patient care.  J Am Coll Radiol. 2014 Mar;11(3):219-20.
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