There are a number of tests and scans that a patient can be asked to undergo as part of their evaluation for receiving PRLT. The exact order in which the patient takes these tests or scans may depend upon their specific medical condition or the need for the doctors to evaluate results in some order.

While the patient is at the Zentralklinik, it is customary for them to be given directions to find the department where tests or scans are performed. For Non-German speaking patients this can be a challenge in that signage is in German and the Zentralklinik is a very large medical center. There are no maps. It is suggested that you write down the directions, if you can. Also it is suggested that you take a book, iPod, iPad or Kindle with you to occupy your time while waiting. It is not unusual to be waiting for an hour or longer before being called for a test or scan.

Blood Lab Work

Once you go to the Ward after checking in with Finance there are usually 3 things to be done: 1) do blood draw for tests, 2) Do tests for dangerous bacteria strains (like MRSA) and 3) have a brief interview with the Doctor on the Ward. The order of these things may vary. 

The blood test is the usual CBC, a liver panel, a kidney panel and some bio-markers. On the Ward they do an inside the cheek swab and one of the nose to check on MRSA (Methicillin-resistant Staphylococcus aureus) and a new test is for 4mrgn (multi-resistant bacteria). This is a swab of the anal area and is self-administered. This is a requirement of all foreign patients on the Nuclear Ward.

Typically an interview is done by the Doctor on the Ward that day. They review your diagnosis, any changes in the past few months in terms of health and your prostate cancer situation situation. The Doctor covers a lot of details about your Prostate Cancer and associated metastases and what may be done at the Zentralklinik while you are there. 

The Scans

Another test is for renal function and this usually takes place first thing on Monday morning. If an ultra sound for the liver or pancreas or a heart echocardiogram is needed, these may come next during the day on Monday or on Tuesday morning.

Dynamic Renal Scintigraphy with Tc-99-MAG3

Typically this is among the first tests/scans to be done on a patient because the function of the kidneys is essential to the PRLT process. The kidneys are key to ridding the body of the radiation that is administered with the PRLT. For this particular test the patient has an IV tube put in place and is injected with a radioactive tracer. The patient is scanned with a gamma camera and these images are used to assess the function of the kidney. A blood sample is also drawn from the patient for analysis related to kidney function. Two measurements are taken:

• Tubular Extraction Rate (TER)

• Glomerular Filtration Rate with Tc-99m-DTPA

The PSMA-68-Gallium PET/CT scan

This scan is among the most important scans the patient will receive at Bad Berka. Typically a patient will do dynamic renal testing prior to the 68-Ga scan, consequently, the IV tube inserted for the renal test will be used for the infusion of the 68-Gallium isotope for this scan. The usual procedure is for the patient to report to the PET center after their renal testing. The patient will be injected with the isotope ( as well as Lasix) and then instructed to wait about 45min to an hour in the waiting area. During that time the patient must drink about 1 liter of a slightly licorice flavored contrast agent and to also drink about a liter of water, all prior to the scan.

It is recommended that during the waiting period, the patient should urinate as much as possible, especially immediately before being called into the scanning room. The dual scans take about 20-30 minutes in total and take place back to back. There is no break in between scans.

This scan is both a PET scan and a CT scan. Usually both scans are done with no stopping. The CT scan uses an injected contrast agent through the IV tube.

Whole Body FDG PET/CT scan

Sometimes the patient is asked to undergo an FDG PET/CT scan as the last step before discharge. For this scan the patient must not take any meals after the evening meal of the night before -- until after the scan. The patient is first injected with a radioactive tracer attached to a glucose solution. About an hour later the patient undergoes a whole body, spiral CT.

The purpose of the scan is to seek out increased glucose metabolic activity that is characteristic of faster growing cancer tumor cell activity.