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Ni X, Wei Y, Li X, Pan J, Fang B, Zhang T, Lu Y, Ye D, Zhu Y. From biology to the clinic - exploring liver metastasis in prostate cancer. Nat Rev Urol 2024:10.1038/s41585-024-00875-x. [PMID: 38671281 DOI: 10.1038/s41585-024-00875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Liver metastases from prostate cancer are associated with an aggressive disease course and poor prognosis. Results from autopsy studies indicate a liver metastasis prevalence of up to 25% in patients with advanced prostate cancer. Population data estimate that ~3-10% of patients with metastatic castration-resistant prostate cancer harbour liver metastases at the baseline, rising to 20-30% in post-treatment cohorts, suggesting that selective pressure imposed by novel therapies might promote metastatic spread to the liver. Liver metastases are associated with more aggressive tumour biology than lung metastases. Molecular profiling of liver lesions showed an enrichment of low androgen receptor, neuroendocrine phenotypes and high genomic instability. Despite advancements in molecular imaging modalities such as prostate-specific membrane antigen PET-CT, and liquid biopsy markers such as circulating tumour DNA, early detection of liver metastases from prostate cancer remains challenging, as both approaches are hampered by false positive and false negative results, impeding the accurate identification of early liver lesions. Current therapeutic strategies showed limited efficacy in this patient population. Emerging targeted radionuclide therapies, metastasis-directed therapy, and novel systemic agents have shown preliminary activity against liver metastases, but require further validation. Treatment with various novel prostate cancer therapies might lead to an increase in the prevalence of liver metastasis, underscoring the urgent need for coordinated efforts across preclinical and clinical researchers to improve characterization, monitoring, and management of liver metastases from prostate cancer. Elucidating molecular drivers of liver tropism and interactions with the liver microenvironment might ultimately help to identify actionable targets to enhance survival in this high-risk patient group.
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Affiliation(s)
- Xudong Ni
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Yu Wei
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Xiaomeng Li
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Jian Pan
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Bangwei Fang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Tingwei Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Ying Lu
- Key Laboratory of Metabolism and Molecular Medicine of the Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Shanghai Medical College of Fudan University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
- Shanghai Genitourinary Cancer Institute, Shanghai, China.
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Li E, Russon A, Chen J, Mansberg V, Mansberg R. Small Cell Neuroendocrine Carcinoma of the Prostate on 18 F-DCFPyL and 18 F-FDG PET/CT. Clin Nucl Med 2024; 49:335-337. [PMID: 38377379 DOI: 10.1097/rlu.0000000000005110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
ABSTRACT A 51-year-old man with newly diagnosed small cell neuroendocrine carcinoma of the prostate was referred for a staging 18 F-DCFPyL PET/CT, which showed a solitary metastasis in the left acetabulum. Subsequent 18 F-FDG PET/CT showed intense uptake throughout the prostate as well as extensive avid pelvic and thoracic nodal disease and redemonstration of the left acetabular metastasis. Despite initial metabolic response to treatment, subsequent 18 F-FDG PET 8 months later revealed significant progression of nodal disease above and below the diaphragm, as well as multiple new sites of metastases.
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Affiliation(s)
- Edward Li
- From the Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood
| | | | - Jeffrey Chen
- From the Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood
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Sarswat S, Das KJ, Kaushal S, Singhal A, Sharma A. Small Cell Carcinoma Prostate: A Case Report with Findings on 18-F FDG PET/CT. Indian J Nucl Med 2024; 39:126-128. [PMID: 38989311 PMCID: PMC11232719 DOI: 10.4103/ijnm.ijnm_122_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 07/12/2024] Open
Abstract
Small-cell carcinoma of the prostate (SCCP) is a rare and very aggressive malignancy with neuroendocrine differentiation. In contrast to conventional prostate adenocarcinoma, SCCP is an aggressive carcinoma and portends to have a poor prognosis. Around 50% of these patients have metastatic disease at the first clinical presentation. We report the findings of 18-F fluorodeoxyglucose positron emission tomography/computed tomography in a case of histologically proven SCCP with an unusual finding of the left internal mammary lymph node.
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Affiliation(s)
- Sulochana Sarswat
- Department of Nuclear Medicine, National Cancer Institute (NCI-AIIIMS), Jhajjar, Haryana, India
| | - Kalpa Jyoti Das
- Department of Nuclear Medicine, National Cancer Institute (NCI-AIIIMS), Jhajjar, Haryana, India
| | | | - Abhinav Singhal
- Department of Nuclear Medicine, National Cancer Institute (NCI-AIIIMS), Jhajjar, Haryana, India
| | - Aparna Sharma
- Department of Medical Oncology, National Cancer Institute (NCI-AIIIMS), Jhajjar, Haryana, India
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Dondi F, Antonelli A, Suardi N, Guerini AE, Albano D, Lucchini S, Camoni L, Treglia G, Bertagna F. PET/CT and Conventional Imaging for the Assessment of Neuroendocrine Prostate Cancer: A Systematic Review. Cancers (Basel) 2023; 15:4404. [PMID: 37686680 PMCID: PMC10486674 DOI: 10.3390/cancers15174404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuroendocrine prostate cancer (NEPC) is a rare neoplasm, and the role of both conventional imaging (CI) and positron emission tomography/computed tomography (PET/CT) for its assessment has not been clearly evaluated and demonstrated. The aim of this systematic review was to analyze the diagnostic performances of these imaging modalities in this setting. METHODS A wide literature search of the PubMed/MEDLINE, Scopus, and Web of Science databases was made to find relevant published articles about the role of CI and PET/CT for the evaluation of NEPC. RESULTS 13 studies were included in the systematic review. PET/CT imaging with different radiopharmaceuticals has been evaluated in many studies (10) compared to CI (3 studies), which has only a limited role in NEPC. Focusing on PET/CT, a study used [18F]FDG, labeled somatostatin analogs were used in 5 cases, a study used [68Ga]Ga-FAPI-04, [68Ga]Ga-PSMA-11 was evaluated in a single case, and two works used different tracers. CONCLUSION Published data on the role of PET/CT for the assessment of NEPC are limited. At present, it is still uncertain which tracer performs best, and although [18F]FDG has been evaluated and seems to offer some advantages in availability and clinical staging, other tracers may be more useful to understand tumor biology or identify targets for subsequent radioligand therapy. Further research is therefore desirable. In contrast, data are still limited to draw a final conclusion on the role and the specific characteristics of CI in this rare form of neoplasm, and therefore, more studies are needed in this setting.
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Affiliation(s)
- Francesco Dondi
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | | | - Nazareno Suardi
- Department of Urology, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Andrea Emanuele Guerini
- Department of Radiation Oncology, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Domenico Albano
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Silvia Lucchini
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Luca Camoni
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Giorgio Treglia
- Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
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Cohen D, Hazut Krauthammer S, Fahoum I, Kesler M, Even-Sapir E. PET radiotracers for whole-body in vivo molecular imaging of prostatic neuroendocrine malignancies. Eur Radiol 2023; 33:6502-6512. [PMID: 37052659 DOI: 10.1007/s00330-023-09619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023]
Abstract
Prostatic neuroendocrine malignancies represent a spectrum of diseases. Treatment-induced neuroendocrine differentiation (tiNED) in hormonally treated adenocarcinoma has been the subject of a large amount of recent research. However, the identification of neuroendocrine features in treatment-naïve prostatic tumor raises a differential diagnosis between prostatic adenocarcinoma with de novo neuroendocrine differentiation (dNED) versus one of the primary prostatic neuroendocrine tumors (P-NETs) and carcinomas (P-NECs). While [18F]FDG is being used as the main PET radiotracer in oncologic imaging and reflects cellular glucose metabolism, other molecules labeled with positron-emitting isotopes, mainly somatostatin-analogues labeled with 68Ga and prostate-specific membrane antigen (PSMA)-ligands labeled with either 18F or 68Ga, are now routinely used in departments of nuclear medicine and molecular imaging, and may be advantageous in imaging prostatic neuroendocrine malignancies. Still, the selection of the preferred PET radiotracer in such cases might be challenging. In the current review, we summarize and discuss published data on these different entities from clinical, biological, and molecular imaging standpoints. Specifically, we review the roles that [18F]FDG, radiolabeled somatostatin-analogues, and radiolabeled PSMA-ligands play in these entities in order to provide the reader with practical recommendations regarding the preferred PET radiotracers for imaging each entity. In cases of tiNED, we conclude that PSMA expression may be low and that [18F]FDG or radiolabeled somatostatin-analogues should be preferred for imaging. In cases of prostatic adenocarcinoma with dNED, we present data that support the superiority of radiolabeled PSMA-ligands. In cases of primary neuroendocrine malignancies, the use of [18F]FDG for imaging high-grade P-NECs and radiolabeled somatostatin-analogues for imaging well-differentiated P-NETs is recommended. KEY POINTS: • The preferred PET radiotracer for imaging prostatic neuroendocrine malignancies depends on the specific clinical scenario and pathologic data. • When neuroendocrine features result from hormonal therapy for prostate cancer, PET-CT should be performed with [18F]FDG or radiolabeled somatostatin-analogue rather than with radiolabeled PSMA-ligand. • When neuroendocrine features are evident in newly diagnosed prostate cancer, differentiating adenocarcinoma from primary neuroendocrine malignancy is challenging but crucial for selection of PET radiotracer and for clinical management.
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Affiliation(s)
- Dan Cohen
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel.
| | - Shir Hazut Krauthammer
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Ibrahim Fahoum
- Institute of Pathology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mikhail Kesler
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shen K, Yu M, Ji Y, Zhou X, Liu B, Zhang W, Su R, Qi J, Wang Q, Xue W. 18 F-FDG PET/CT imaging in neuroendocrine prostate cancer: Relation to histopathology and prognosis. Prostate 2023; 83:1167-1175. [PMID: 37189301 DOI: 10.1002/pros.24559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of 18 F-fluoro-2-deoxy-D-glucose Positron emission tomography/computed tomography (18 F-FDG PET/CT) in predicting prognosis and characterizing the intratumoral glucose uptake of neuroendocrine prostate cancer (NEPC). METHODS We retrospectively reviewed 189 NEPC patients from two medical centers between January 2009 and April 2021. Of these, 44 patients met the inclusion criteria. The maximum standardized uptake value (SUVmax) was measured to assess the metabolic state of NEPC and comparison were made between different histopathological subtypes. Kaplan-Meier and Cox regression analyses were performed to evaluate the predictive value of SUVmax on overall survival (OS) and progression-free survival (PFS). RESULTS This study analyzed 44 NEPC patients and found that 13 patients had small cell neuroendocrine carcinoma (SCNC), while 31 were diagnosed with adenocarcinoma with neuroendocrine differentiation (Ad-NED) based on histopathology, and a positive correlation was found between SUVmax and SCNC via Spearman correlation test (rs = 0.60, p < 0.0001). Furthermore, SUVmax demonstrated good diagnostic accuracy in differentiating SCNC from Ad-NED (area under the curve 0.88, 95% confidence interval [CI] 0.76-0.99). Kaplan-Meier survival analyses and univariate analyses revealed that patients with SUVmax > 10.2 had a significantly shorter OS than patients with SUVmax ≤ 10.2 (hazard ratio = 4.83, 95% CI 1.45-16.1, p = 0.01). CONCLUSIONS The histopathological subtypes in NEPC showed a close correlation with the glucose metabolic activity of primary tumors as assessed by 18 F-FDG PET/CT. High SUVmax values in primary prostate tumors were associated with a worse OS in NEPC patients.
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Affiliation(s)
- Kai Shen
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minghao Yu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyi Ji
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Zhou
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Liu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruopeng Su
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Wang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory for Tumor Microenvironment and Inflammation, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Elakshar S, Tolba M, Tisseverasinghe S, Pruneau L, Di Lalla V, Bahoric B, Niazi T. Salvage Whole-Pelvic Radiation and Long-Term Androgen-Deprivation Therapy in the Management of High-Risk Prostate Cancer: Long-Term Update of the McGill 0913 Study. Curr Oncol 2023; 30:7252-7262. [PMID: 37623007 PMCID: PMC10453184 DOI: 10.3390/curroncol30080526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE To report the long-term outcomes of the McGill 0913 study and the potential benefits of combining prostate-bed radiotherapy (PBRT), pelvic-lymph-node radiotherapy (PLNRT), and long term ADT (LT-ADT). MATERIALS AND METHODS From 2010 to 2016, 46 high-risk prostate cancer patients who experienced biochemical recurrence (BCR) after radical prostatectomy (RP) were enrolled in this single-arm phase II clinical trial. The patients were eligible if they had a Gleason score > 8, locally advanced disease (≥pT3), a preoperative PSA of >20 ng/mL, or positive lymph nodes (LN). The patients were treated with a combination of 24 months of ADT, PBRT, and PLNRT. The primary outcome was biochemical progression-free survival (bPFS) and the predefined secondary endpoints included distant-metastasis-free survival (DMFS), overall survival (OS), and toxicity. In this update, we also report the median follow-up of 8.8 years and 10 years OS. RESULTS At a median follow-up of 8.8 years, 43 patients were eligible for analysis. The median pre-salvage PSA was 0.30 μg/L. Half (51%) of the patients (n = 22) had positive margins, 40% (n = 17) had Gleason scores > 8, 63% (n = 27) had extracapsular extension, 42% (n = 18) had seminal vesicle invasion, and 19% (n = 8) had LN involvement. The 10-year bPFS was 68.3 %. The 10-year DMFS was 72.9%. The 10-year OS was 97%. There were two non-cancer-related deaths. The first patient died of congestive heart failure while the other died of an unknown cause. No new toxicity was observed after the initial report. CONCLUSIONS Our study demonstrates that treatment escalation with PBRT, PLNRT, and LT-ADT improves long term outcomes. In view of the recently published SPPORT study, we conclude that this novel approach of treatment intensification in high-risk post-prostatectomy patients is safe and effective, and that it should be offered as the standard of care.
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Affiliation(s)
- Sara Elakshar
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
- Department of Clinical Oncology, Tanta University Hospitals, Tanta University, Tanta 6632110, Egypt
| | - Marwan Tolba
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
| | - Steven Tisseverasinghe
- Department of Radiation Oncology, Gatineau Hospital, McGill University, Gatineau, QC J8P 7H2, Canada;
| | - Laurie Pruneau
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
| | - Vanessa Di Lalla
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
| | - Boris Bahoric
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
| | - Tamim Niazi
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (S.E.); (M.T.); (L.P.); (V.D.L.); (B.B.)
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Chetta P, Sriram R, Zadra G. Lactate as Key Metabolite in Prostate Cancer Progression: What Are the Clinical Implications? Cancers (Basel) 2023; 15:3473. [PMID: 37444583 DOI: 10.3390/cancers15133473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Advanced prostate cancer represents the fifth leading cause of cancer death in men worldwide. Although androgen-receptor signaling is the major driver of the disease, evidence is accumulating that disease progression is supported by substantial metabolic changes. Alterations in de novo lipogenesis and fatty acid catabolism are consistently reported during prostate cancer development and progression in association with androgen-receptor signaling. Therefore, the term "lipogenic phenotype" is frequently used to describe the complex metabolic rewiring that occurs in prostate cancer. However, a new scenario has emerged in which lactate may play a major role. Alterations in oncogenes/tumor suppressors, androgen signaling, hypoxic conditions, and cells in the tumor microenvironment can promote aerobic glycolysis in prostate cancer cells and the release of lactate in the tumor microenvironment, favoring immune evasion and metastasis. As prostate cancer is composed of metabolically heterogenous cells, glycolytic prostate cancer cells or cancer-associated fibroblasts can also secrete lactate and create "symbiotic" interactions with oxidative prostate cancer cells via lactate shuttling to sustain disease progression. Here, we discuss the multifaceted role of lactate in prostate cancer progression, taking into account the influence of the systemic metabolic and gut microbiota. We call special attention to the clinical opportunities of imaging lactate accumulation for patient stratification and targeting lactate metabolism.
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Affiliation(s)
- Paolo Chetta
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Giorgia Zadra
- Institute of Molecular Genetics, National Research Council (IGM-CNR), 27100 Pavia, Italy
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Kemble J, Kwon ED, Karnes RJ. Addressing the need for more therapeutic options in neuroendocrine prostate cancer. Expert Rev Anticancer Ther 2023; 23:177-185. [PMID: 36698089 DOI: 10.1080/14737140.2023.2173174] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Neuroendocrine prostate cancer (NEPC) is an aggressive form of prostate cancer frequently seen after prolonged treatment of castration resistant prostate cancer (CRPC). NEPC has become increasingly prevalent over the last 20 years, with a poor prognosis caused by a late diagnosis and limited treatment options. Recent advances in PET/CT imaging and targeted radioimmunotherapy are promising, but more research into additional treatment options is needed. AREAS COVERED The aim of this review is to analyze the current imaging and treatment options for NEPC, and to highlight future potential treatment strategies. A Pubmed search for 'Neuroendocrine Prostate Cancer' was performed and relevant articles were reviewed. EXPERT OPINION The recent FDA approval and success of 177 PSMA Lutetium in CRPC is promising, as 177 Lutetium could potentially be paired with a NEPC specific biomarker for targeted therapy. Recent laboratory studies pairing DLL3, which is overexpressed in NEPC, with 177 Lutetium and new PET agents have showed good efficacy in identifying and treating NEPC. The success of future development of NEPC therapies may depend on the availability of 177 Lutetium, as current supplies are limited. Further research into additional imaging and treatment options for NEPC is warranted.
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Affiliation(s)
- Jayson Kemble
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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10
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Mossa F, Robesti D, Sumankalai R, Corey E, Titus M, Kang Y, Zhang J, Briganti A, Montorsi F, Vellano CP, Marszaleck JR, Frigo DE, Logothetis CJ, Gujral TS, Dondossola E. Subtype and Site Specific-Induced Metabolic Vulnerabilities in Prostate Cancer. Mol Cancer Res 2023; 21:51-61. [PMID: 36112348 PMCID: PMC9812897 DOI: 10.1158/1541-7786.mcr-22-0250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/26/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
Aberrant metabolic functions play a crucial role in prostate cancer progression and lethality. Currently, limited knowledge is available on subtype-specific metabolic features and their implications for treatment. We therefore investigated the metabolic determinants of the two major subtypes of castration-resistant prostate cancer [androgen receptor-expressing prostate cancer (ARPC) and aggressive variant prostate cancer (AVPC)]. Transcriptomic analyses revealed enrichment of gene sets involved in oxidative phosphorylation (OXPHOS) in ARPC tumor samples compared with AVPC. Unbiased screening of metabolic signaling pathways in patient-derived xenograft models by proteomic analyses further supported an enrichment of OXPHOS in ARPC compared with AVPC, and a skewing toward glycolysis by AVPC. In vitro, ARPC C4-2B cells depended on aerobic respiration, while AVPC PC3 cells relied more heavily on glycolysis, as further confirmed by pharmacologic interference using IACS-10759, a clinical-grade inhibitor of OXPHOS. In vivo studies confirmed IACS-10759's inhibitory effects in subcutaneous and bone-localized C4-2B tumors, and no effect in subcutaneous PC3 tumors. Unexpectedly, IACS-10759 inhibited PC3 tumor growth in bone, indicating microenvironment-induced metabolic reprogramming. These results suggest that castration-resistant ARPC and AVPC exhibit different metabolic dependencies, which can further undergo metabolic reprogramming in bone. IMPLICATIONS These vulnerabilities may be exploited with mechanistically novel treatments, such as those targeting OXPHOS alone or possibly in combination with existing therapies. In addition, our findings underscore the impact of the tumor microenvironment in reprogramming prostate cancer metabolism.
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Affiliation(s)
- Federica Mossa
- David H. Koch Center for Applied Research of Genitourinary Cancers and Genitourinary Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030
| | - Daniele Robesti
- David H. Koch Center for Applied Research of Genitourinary Cancers and Genitourinary Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030,Department of Urology, Urological Research Institute, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy, 20152
| | - Ramachandran Sumankalai
- David H. Koch Center for Applied Research of Genitourinary Cancers and Genitourinary Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030
| | - Eva Corey
- Department of Urology, University of Washington, Seattle, Washington, WA 98195
| | - Mark Titus
- David H. Koch Center for Applied Research of Genitourinary Cancers and Genitourinary Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030
| | - Yuqi Kang
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109; Department of Molecular and Cellular Biology, University of Washington, Seattle, WA 98195
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy, 20152
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy, 20152
| | - Christopher P. Vellano
- TRACTION Platform, Therapeutics Discovery Division, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030
| | - Joseph R. Marszaleck
- TRACTION Platform, Therapeutics Discovery Division, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030
| | - Daniel E. Frigo
- David H. Koch Center for Applied Research of Genitourinary Cancers and Genitourinary Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030,Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030
| | - Christopher J Logothetis
- David H. Koch Center for Applied Research of Genitourinary Cancers and Genitourinary Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030
| | - Taranjit S. Gujral
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109; Department of Molecular and Cellular Biology, University of Washington, Seattle, WA 98195
| | - Eleonora Dondossola
- David H. Koch Center for Applied Research of Genitourinary Cancers and Genitourinary Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030,Corresponding author: Eleonora Dondossola, 1515 Holcombe Blvd, Houston, Texas, 77030, +17137459200
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11
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Shahrokhi P, Emami-Ardekani A, Karamzade-Ziarati N. SSTR-based theranostics in neuroendocrine prostate cancer (NEPC). Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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12
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Choi SYC, Ribeiro CF, Wang Y, Loda M, Plymate SR, Uo T. Druggable Metabolic Vulnerabilities Are Exposed and Masked during Progression to Castration Resistant Prostate Cancer. Biomolecules 2022; 12:1590. [PMID: 36358940 PMCID: PMC9687810 DOI: 10.3390/biom12111590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 08/27/2023] Open
Abstract
There is an urgent need for exploring new actionable targets other than androgen receptor to improve outcome from lethal castration-resistant prostate cancer. Tumor metabolism has reemerged as a hallmark of cancer that drives and supports oncogenesis. In this regard, it is important to understand the relationship between distinctive metabolic features, androgen receptor signaling, genetic drivers in prostate cancer, and the tumor microenvironment (symbiotic and competitive metabolic interactions) to identify metabolic vulnerabilities. We explore the links between metabolism and gene regulation, and thus the unique metabolic signatures that define the malignant phenotypes at given stages of prostate tumor progression. We also provide an overview of current metabolism-based pharmacological strategies to be developed or repurposed for metabolism-based therapeutics for castration-resistant prostate cancer.
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Affiliation(s)
- Stephen Y. C. Choi
- Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Experimental Therapeutics, BC Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Caroline Fidalgo Ribeiro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, USA
| | - Yuzhuo Wang
- Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Experimental Therapeutics, BC Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Massimo Loda
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10021, USA
- New York Genome Center, New York, NY 10013, USA
| | - Stephen R. Plymate
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, 850 Republican St., Seattle, WA 98109, USA
- Geriatrics Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Takuma Uo
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, 850 Republican St., Seattle, WA 98109, USA
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13
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Bergamini M, Dalla Volta A, Caramella I, Bercich L, Fisogni S, Bertoli M, Valcamonico F, Grisanti S, Poliani PL, Bertagna F, Berruti A. Case Report: 18F-PSMA PET/CT Scan in Castration Resistant Prostate Cancer With Aggressive Neuroendocrine Differentiation. Front Oncol 2022; 12:937713. [PMID: 35936689 PMCID: PMC9354022 DOI: 10.3389/fonc.2022.937713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
The development of a neuroendocrine phenotype as a mechanism of resistance to hormonal treatment is observed in up to 20% of advanced prostate cancer patients. High grade neuroendocrine prostate cancer (NEPC) is associated to poor prognosis and the therapeutic armamentarium is restricted to platinum-based chemotherapy. Prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) imaging has recently emerged as a potential new standard for the staging of prostate cancer and PSMA-based radioligand therapy (RLT) as a therapeutic option in advanced metastatic castration resistant prostate cancer (mCRPC). PSMA-based theranostic is not currently applied in the staging and treatment of NEPC since PSMA expression on neuroendocrine differentiated cells was shown to be lost. In this case series, we present 3 consecutive mCRPC patients with histologically proven high grade neuroendocrine differentiation who underwent PSMA-PET/CT and surprisingly showed high tracer uptake. This observation stimulates further research on the use of PSMA-based theranostic in the management of NEPC.
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Affiliation(s)
- Marco Bergamini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alberto Dalla Volta
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
- *Correspondence: Alberto Dalla Volta, alberto.
| | - Irene Caramella
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Luisa Bercich
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Simona Fisogni
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Mattia Bertoli
- Nuclear Medicine Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Valcamonico
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Pietro Luigi Poliani
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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14
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Iravani A, Parihar AS, Akhurst T, Hicks RJ. Molecular imaging phenotyping for selecting and monitoring radioligand therapy of neuroendocrine neoplasms. Cancer Imaging 2022; 22:25. [PMID: 35659779 PMCID: PMC9164531 DOI: 10.1186/s40644-022-00465-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
Neuroendocrine neoplasia (NEN) is an umbrella term that includes a widely heterogeneous disease group including well-differentiated neuroendocrine tumours (NETs), and aggressive neuroendocrine carcinomas (NECs). The site of origin of the NENs is linked to the intrinsic tumour biology and is predictive of the disease course. It is understood that NENs demonstrate significant biologic heterogeneity which ultimately translates to widely varying clinical presentations, disease course and prognosis. Thus, significant emphasis is laid on the pre-therapy evaluation of markers that can help predict tumour behavior and dynamically monitors the response during and after treatment. Most well-differentiated NENs express somatostatin receptors (SSTRs) which make them appropriate for peptide receptor radionuclide therapy (PRRT). However, the treatment outcomes of PRRT depend heavily on the adequacy of patient selection by molecular imaging phenotyping not only utilizing pre-treatment SSTR PET but 18F-Fluorodeoxyglucose (18F-FDG) PET to provide insights into the intra- or inter-tumoural heterogeneity of the metastatic disease. Molecular imaging phenotyping may go beyond patient selection and provide useful information during and post-treatment for monitoring of temporal heterogeneity of the disease and dynamically risk-stratify patients. In addition, advances in the understanding of genomic-phenotypic classifications of pheochromocytomas and paragangliomas led to an archetypical example in precision medicine by utilizing molecular imaging phenotyping to guide radioligand therapy. Novel non-SSTR based peptide receptors have also been explored diagnostically and therapeutically to overcome the tumour heterogeneity. In this paper, we review the current molecular imaging modalities that are being utilized for the characterization of the NENs with special emphasis on their role in patient selection for radioligand therapy.
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15
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Vargas Ahumada J, González Rueda SD, Sinisterra Solís FA, Pitalúa Cortés Q, Torres Agredo LP, Miguel JR, Scavuzzo A, Soldevilla-Gallardo I, Álvarez Avitia MA, Sobrevilla N, García Pérez FO. Multitarget Molecular Imaging in Metastatic Castration Resistant Adenocarcinoma Prostate Cancer with Therapy Induced Neuroendocrine Differentiation. Diagnostics (Basel) 2022; 12:diagnostics12061387. [PMID: 35741197 PMCID: PMC9221809 DOI: 10.3390/diagnostics12061387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Neuroendocrine differentiation of prostate cancer (NEDPC) includes de novo presentation and secondary to epigenetic changes, referred as therapy-induced neuroendocrine prostate cancer (t-NEPC). Molecular imaging with prostate-specific membrane antigen (PSMA) and somatostatin analogues positron emission tomography (PET/CT) in NEDPC have not been validated. 18F-FDG (fluorodeoxyglucose) PET/CT has numerous limitations in prostate cancer (PCa) and the utility in NEDPC has only been reported in a few series of cases. The objective of this study is to compare the lesions detection rate of the three radiotracers in metastatic t-NEPC patients. (1) Material and Methods: Retrospective evaluation of patients with prostate adenocarcinoma treated with androgen deprivation therapy, chemotherapy, a novel androgen receptor pathway inhibitor or a combination of them and a second tumour biopsy confirming t-NEPC was made. All patients underwent 18F PSMA-1007, 18F AlF-NOTA-Octreotide, and 18F-FDG PET/CT. Evaluation of positive lesions was determined and SUVmax of each radiotracer was estimated and correlated with computer tomography (CT) findings. (2) Results: A total of eight patients were included. The mean time from diagnosis of prostate adenocarcinoma to t-NEPC was 28.2 months, with a mean serum specific prostate antigen (PSA) of 16.6 ng/dl at the time of NEPC diagnosis. All patients were treated with antiandrogen therapy and 87.5% with chemotherapy. A total of 273 lesions were identified by CT from which 182 were detected by 18F-FDG PET/CT, 174 lesions by 18F PSMA-1007, and 59 by 18F AlF-NOTA-Octreotide. An interpatient analysis of the lesions was performed and dual tracer 18F-FDG PET/CT and 18F PSMA-1007 PET/CT detected a total of 270/273 lesions (98.9%). (3) Conclusions: NEDPC patients demonstrated wide inter and intrapatient molecular imaging heterogeneity within the three radiotracers. 18F-FDG detected most lesions in t-NEPC among all radiotracers, especially in visceral sites; 18F PSMA-1007 detected more bone lesions. 18F AlF-NOTA-Octreotide showed no significant utility.
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Affiliation(s)
- Joel Vargas Ahumada
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (J.V.A.); (S.D.G.R.); (F.A.S.S.); (Q.P.C.); (I.S.-G.)
| | - Sofía D. González Rueda
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (J.V.A.); (S.D.G.R.); (F.A.S.S.); (Q.P.C.); (I.S.-G.)
| | - Fabio A. Sinisterra Solís
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (J.V.A.); (S.D.G.R.); (F.A.S.S.); (Q.P.C.); (I.S.-G.)
| | - Quetzali Pitalúa Cortés
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (J.V.A.); (S.D.G.R.); (F.A.S.S.); (Q.P.C.); (I.S.-G.)
| | | | - Jimenez Ríos Miguel
- Urological Oncology Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (J.R.M.); (A.S.)
| | - Anna Scavuzzo
- Urological Oncology Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (J.R.M.); (A.S.)
| | - Irma Soldevilla-Gallardo
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (J.V.A.); (S.D.G.R.); (F.A.S.S.); (Q.P.C.); (I.S.-G.)
| | - Miguel A. Álvarez Avitia
- Medical Oncology Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (M.A.Á.A.); (N.S.)
| | - Nora Sobrevilla
- Medical Oncology Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (M.A.Á.A.); (N.S.)
| | - Francisco Osvaldo García Pérez
- Nuclear Medicine and Molecular Imaging Department, National Cancer Institute, Tlalpan, Mexico City 14080, Mexico; (J.V.A.); (S.D.G.R.); (F.A.S.S.); (Q.P.C.); (I.S.-G.)
- Correspondence:
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16
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Eshghi A, Covington MF, Eshghi N, Kuo PH. Utility of PET to Appropriately Select Patients for PSMA-Targeted Theranostics. Clin Nucl Med 2022; 47:488-495. [PMID: 35384904 DOI: 10.1097/rlu.0000000000004196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT The majority of aggressive prostate cancers overexpress the transmembrane protein prostate-specific membrane antigen (PSMA). PSMA is, therefore, an attractive target for drug development. Over the last decade, numerous PSMA-targeted radiopharmaceuticals for imaging and therapy have been developed and investigated in theranostic combination. PSMA-targeted radiopharmaceuticals for imaging have been primarily developed for PET. PSMA PET provides whole-body evaluation of the degree of PSMA expression on tumors and potentially provides a method to better select patients for PSMA-targeted therapy. Numerous PSMA-targeted therapeutic agents using β- or α-particle emitters are under study in clinical trials. In particular, the β-particle-emitting radioisotope 177Lu bound to PSMA-targeted small molecules have ongoing and completed late-stage clinical trials in metastatic castration-resistant prostate cancer. To define the most appropriate patient group for PSMA-targeted therapeutics, multiple studies have investigated PSMA and FDG PET/CT to establish PET parameters as predictive and prognostic biomarkers. This article discusses recent clinical trials that examine the optimal use of PET for the selection of patients for PSMA-targeted therapeutics and provides an integrative overview of choice of PET tracer(s), targeting molecule, therapeutic radioisotope, nonradioactive therapy, and cancer type (prostate or nonprostate).
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Affiliation(s)
- Anna Eshghi
- From the College of Osteopathic Medicine, Kansas City University, Joplin, MO
| | - Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT
| | - Naghmehossadat Eshghi
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Phillip H Kuo
- Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, AZ
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17
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Gu J, Lu Y, Xu G. Mismatched Lesions on 18F-FDG PET and 18F-Fluciclovine PET Images in a Patient With Metastatic Prostate Small Cell Carcinoma. Clin Nucl Med 2022; 47:255-257. [PMID: 34392287 DOI: 10.1097/rlu.0000000000003864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 65-year-old man with fluciclovine-avid metastatic prostate small cell carcinoma with prostate-specific antigen (PSA) 19.4 ng/mL at diagnosis underwent system therapy and subsequent surgery and achieved hormonal response with PSA <0.1 ng/mL. An 18F-fluciclovine PET/CT scan 3 months after surgery was negative for disease. Although PSA remained <0.1 ng/mL, the rising carcinoembryonic antigen prompted an 18F-FDG PET/CT 6 weeks later. It showed multiple hypermetabolic lesions in the prostatectomy bed, liver, and right iliac bone, suggestive of malignant disease. The FDG-avid prostatectomy lesions were further confirmed on MRI. This case demonstrates that FDG PET/CT has a role in suspected metastatic prostate small cell carcinoma with negative fluciclovine PET examination.
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Affiliation(s)
- Joshua Gu
- From the Department of Diagnostic Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Yang Lu
- Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Guofan Xu
- Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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18
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Kelly JM, Jeitner TM, Waterhouse NN, Qu W, Linstad EJ, Samani B, Williams C, Nikolopoulou A, Amor-Coarasa A, DiMagno SG, Babich JW. Synthesis and Evaluation of 11C-Labeled Triazolones as Probes for Imaging Fatty Acid Synthase Expression by Positron Emission Tomography. Molecules 2022; 27:1552. [PMID: 35268652 PMCID: PMC8911806 DOI: 10.3390/molecules27051552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Cancer cells require lipids to fulfill energetic, proliferative, and signaling requirements. Even though these cells can take up exogenous fatty acids, the majority exhibit a dependency on de novo fatty acid synthesis. Fatty acid synthase (FASN) is the rate-limiting enzyme in this process. Expression and activity of FASN is elevated in multiple cancers, where it correlates with disease progression and poor prognosis. These observations have sparked interest in developing methods of detecting FASN expression in vivo. One promising approach is the imaging of radiolabeled molecular probes targeting FASN by positron emission tomography (PET). However, although [11C]acetate uptake by prostate cancer cells correlates with FASN expression, no FASN-specific PET probes currently exist. Our aim was to synthesize and evaluate a series of small molecule triazolones based on GSK2194069, an FASN inhibitor with IC50 = 7.7 ± 4.1 nM, for PET imaging of FASN expression. These triazolones were labeled with carbon-11 in good yield and excellent radiochemical purity, and binding to FASN-positive LNCaP cells was significantly higher than FASN-negative PC3 cells. Despite these promising characteristics, however, these molecules exhibited poor in vivo pharmacokinetics and were predominantly retained in lymph nodes and the hepatobiliary system. Future studies will seek to identify structural modifications that improve tumor targeting while maintaining the excretion profile of these first-generation 11C-methyltriazolones.
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Affiliation(s)
- James M. Kelly
- Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (T.M.J.); (C.W.J.); (A.N.); (A.A.-C.); (J.W.B.)
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY 10021, USA; (N.N.W.); (W.Q.)
| | - Thomas M. Jeitner
- Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (T.M.J.); (C.W.J.); (A.N.); (A.A.-C.); (J.W.B.)
| | - Nicole N. Waterhouse
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY 10021, USA; (N.N.W.); (W.Q.)
| | - Wenchao Qu
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY 10021, USA; (N.N.W.); (W.Q.)
| | - Ethan J. Linstad
- Departments of Medicinal Chemistry & Pharmacognosy and Chemistry, University of Illinois-Chicago, Chicago, IL 60612, USA; (E.J.L.); (B.S.); (S.G.D.)
- Department of Chemistry, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Banafshe Samani
- Departments of Medicinal Chemistry & Pharmacognosy and Chemistry, University of Illinois-Chicago, Chicago, IL 60612, USA; (E.J.L.); (B.S.); (S.G.D.)
| | - Clarence Williams
- Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (T.M.J.); (C.W.J.); (A.N.); (A.A.-C.); (J.W.B.)
| | - Anastasia Nikolopoulou
- Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (T.M.J.); (C.W.J.); (A.N.); (A.A.-C.); (J.W.B.)
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY 10021, USA; (N.N.W.); (W.Q.)
| | - Alejandro Amor-Coarasa
- Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (T.M.J.); (C.W.J.); (A.N.); (A.A.-C.); (J.W.B.)
| | - Stephen G. DiMagno
- Departments of Medicinal Chemistry & Pharmacognosy and Chemistry, University of Illinois-Chicago, Chicago, IL 60612, USA; (E.J.L.); (B.S.); (S.G.D.)
| | - John W. Babich
- Molecular Imaging Innovations Institute (MI3), Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (T.M.J.); (C.W.J.); (A.N.); (A.A.-C.); (J.W.B.)
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY 10021, USA; (N.N.W.); (W.Q.)
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10065, USA
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19
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Borea R, Favero D, Miceli A, Donegani MI, Raffa S, Gandini A, Cremante M, Marini C, Sambuceti G, Zanardi E, Morbelli S, Fornarini G, Rebuzzi SE, Bauckneht M. Beyond the Prognostic Value of 2-[18F]FDG PET/CT in Prostate Cancer: A Case Series and Literature Review Focusing on the Diagnostic Value and Impact on Patient Management. Diagnostics (Basel) 2022; 12:diagnostics12030581. [PMID: 35328134 PMCID: PMC8947589 DOI: 10.3390/diagnostics12030581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/04/2022] Open
Abstract
The role of 2-deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in the management of prostate cancer (PCa) patients is increasingly recognised. However, its clinical role is still controversial. Many published studies showed that FDG PET/CT might have a prognostic value in the metastatic castration-resistant phase of the disease, but its role in other settings of PCa and, more importantly, its impact on final clinical management remains to be further investigated. We describe a series of six representative clinical cases of PCa in different clinical settings, but all characterised by a measurable clinical impact of FDG PET/CT on the patients’ management. Starting from their clinical history, we report a concise narrative literature review on the advantages and limitations of FDG PET/CT beyond its prognostic value in PCa. What emerges is that in selected cases, this imaging technique may represent a useful tool in managing PCa patients. However, in the absence of dedicated studies to define the optimal clinical setting of its application, no standard recommendations on its use in PCa patients can be made.
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Affiliation(s)
- Roberto Borea
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, 16132 Genova, Italy
| | - Diletta Favero
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, 16132 Genova, Italy
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Alberto Miceli
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Maria Isabella Donegani
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Stefano Raffa
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Annalice Gandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, 16132 Genova, Italy
| | - Malvina Cremante
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, 16132 Genova, Italy
| | - Cecilia Marini
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- CNR Institute of Molecular Bioimaging and Physiology (IBFM), 20054 Segrate, Italy
| | - Gianmario Sambuceti
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Silvia Morbelli
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Sara Elena Rebuzzi
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, 16132 Genova, Italy
- Medical Oncology Unit, Ospedale San Paolo, 17100 Savona, Italy
| | - Matteo Bauckneht
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Correspondence:
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PARP Inhibitors and Radiometabolic Approaches in Metastatic Castration-Resistant Prostate Cancer: What’s Now, What’s New, and What’s Coming? Cancers (Basel) 2022; 14:cancers14040907. [PMID: 35205654 PMCID: PMC8869833 DOI: 10.3390/cancers14040907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Prostate cancer still represents an important health problem in men, considering its high frequency. Over the last decade, novel treatment options have emerged, leading to notable clinical benefits. These recent scientific acquisitions are creating the basis to widen the treatment scenario of this tumor, evolving from targeting the androgen receptor axis or the traditional chemotherapy approach. Abstract In recent years, the advances in the knowledge on the molecular characteristics of prostate cancer is allowing to explore novel treatment scenarios. Furthermore, technological discoveries are widening diagnostic and treatment weapons at the clinician disposal. Among these, great relevance is being gained by PARP inhibitors and radiometabolic approaches. The result is that DNA repair genes need to be altered in a high percentage of patients with metastatic prostate cancer, making these patients optimal candidates for PARP inhibitors. These compounds have already been proved to be active in pretreated patients and are currently being investigated in other settings. Radiometabolic approaches combine specific prostate cancer cell ligands to radioactive particles, thus allowing to deliver cytotoxic radiations in cancer cells. Among these, radium-223 and lutetium-177 have shown promising activity in metastatic pretreated prostate cancer patients and further studies are ongoing to expand the applications of this therapeutic approach. In addition, nuclear medicine techniques also have an important diagnostic role in prostate cancer. Herein, we report the state of the art on the knowledge on PARP inhibitors and radiometabolic approaches in advanced prostate cancer and present ongoing clinical trials that will hopefully expand these two treatment fields.
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Identification of alternative protein targets of glutamate-ureido-lysine associated with PSMA tracer uptake in prostate cancer cells. Proc Natl Acad Sci U S A 2022; 119:2025710119. [PMID: 35064078 PMCID: PMC8795759 DOI: 10.1073/pnas.2025710119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 12/21/2022] Open
Abstract
Glutamate-ureido-lysine (GUL) probes are specific for prostate-specific membrane antigen (PSMA), overexpressed by most prostate cancers. This antigen can be lost as the cancer progresses. Recent reports have indicated that GUL probes can still identify these PSMA-negative tumors, indicating that the expression of alternative PSMA-like proteins may change during disease progression. In this study we identified two such candidate protein targets, NAALADaseL and mGluR8, by using a combined computational chemistry, data mining, molecular biology, radiochemistry, and synthetic chemistry approach. This work consequently prepares the groundwork for developing specific probes that can identify this progression, indicates directions for neuroendocrine prostate cancer research, and highlights the utility of a multidisciplinary approach for the rapid identification of unidentified proteins interacting with diagnostic probes. Prostate-specific membrane antigen (PSMA) is highly overexpressed in most prostate cancers and is clinically visualized using PSMA-specific probes incorporating glutamate-ureido-lysine (GUL). PSMA is effectively absent from certain high-mortality, treatment-resistant subsets of prostate cancers, such as neuroendocrine prostate cancer (NEPC); however, GUL-based PSMA tracers are still reported to have the potential to identify NEPC metastatic tumors. These probes may bind unknown proteins associated with PSMA-suppressed cancers. We have identified the up-regulation of PSMA-like aminopeptidase NAALADaseL and the metabotropic glutamate receptors (mGluRs) in PSMA-suppressed prostate cancers and find that their expression levels inversely correlate with PSMA expression and are associated with GUL-based radiotracer uptake. Furthermore, we identify that NAALADaseL and mGluR expression correlates with a unique cell cycle signature. This provides an opportunity for the future study of the biology of NEPC and potential therapeutic directions. Computationally predicting that GUL-based probes bind well to these targets, we designed and synthesized a fluorescent PSMA tracer to investigate these proteins in vitro, where it shows excellent affinity for PSMA, NAALADaseL, and specific mGluRs associated with poor prognosis.
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22
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Razmaria AA, Schoder H, Morris MJ. Advances in Prostate Cancer Imaging. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Validation of SV2A-Targeted PET Imaging for Noninvasive Assessment of Neuroendocrine Differentiation in Prostate Cancer. Int J Mol Sci 2021; 22:ijms222313085. [PMID: 34884893 PMCID: PMC8657802 DOI: 10.3390/ijms222313085] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
Neuroendocrine prostate cancer (NEPC) is an aggressive and lethal variant of prostate cancer (PCa), and it remains a diagnostic challenge. Herein we report our findings of using synaptic vesicle glycoprotein 2 isoform A (SV2A) as a promising marker for positron emission tomography (PET) imaging of neuroendocrine differentiation (NED). The bioinformatic analyses revealed an amplified SV2A gene expression in clinical samples of NEPC versus castration-resistant PCa with adenocarcinoma characteristics (CRPC-Adeno). Importantly, significantly upregulated SV2A protein levels were found in both NEPC cell lines and tumor tissues. PET imaging studies were carried out in NEPC xenograft models with 18F-SynVesT-1. Although 18F-SynVesT-1 is not a cancer imaging agent, it showed a significant uptake level in the SV2A+ tumor (NCI-H660: 0.70 ± 0.14 %ID/g at 50–60 min p.i.). The SV2A blockade resulted in a significant reduction of tumor uptake (0.25 ± 0.03 %ID/g, p = 0.025), indicating the desired SV2A imaging specificity. Moreover, the comparative PET imaging study showed that the DU145 tumors could be clearly visualized by 18F-SynVesT-1 but not 68Ga-PSMA-11 nor 68Ga-DOTATATE, further validating the role of SV2A-targeted imaging for noninvasive assessment of NED in PCa. In conclusion, we demonstrated that SV2A, highly expressed in NEPC, can serve as a promising target for noninvasive imaging evaluation of NED.
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24
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Imaging of Neuroendocrine Prostatic Carcinoma. Cancers (Basel) 2021; 13:cancers13225765. [PMID: 34830919 PMCID: PMC8616225 DOI: 10.3390/cancers13225765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 12/27/2022] Open
Abstract
Neuroendocrine prostate cancer (NEPC) is an aggressive subtype of prostate cancer that typically has a high metastatic potential and poor prognosis in comparison to the adenocarcinoma subtype. Although it can arise de novo, NEPC much more commonly occurs as a mechanism of treatment resistance during therapy for conventional prostatic adenocarcinoma, the latter is also termed as castration-resistant prostate cancer (CRPC). The incidence of NEPC increases after hormonal therapy and they represent a challenge, both in the radiological and pathological diagnosis, as well as in the clinical management. This article provides a comprehensive imaging review of prostatic neuroendocrine tumors.
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25
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Berchuck JE, Viscuse PV, Beltran H, Aparicio A. Clinical considerations for the management of androgen indifferent prostate cancer. Prostate Cancer Prostatic Dis 2021; 24:623-637. [PMID: 33568748 PMCID: PMC8353003 DOI: 10.1038/s41391-021-00332-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/16/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many systemic therapies for advanced prostate cancer work by disrupting androgen receptor signaling. Androgen indifferent prostate cancer (AIPC) variants, including aggressive variant prostate cancer (AVPC), neuroendocrine prostate cancer (NEPC), and double-negative prostate cancer (DNPC), are increasingly common and often overlapping resistance phenotypes following treatment with androgen receptor signaling inhibitors in men with metastatic castration-resistant prostate cancer and are associated with poor outcomes. Understanding the underlying biology and identifying effective therapies for AIPC is paramount for improving survival for men with prostate cancer. METHODS In this review, we summarize the current knowledge on AIPC variants, including our current understanding of the clinical, morphologic, and molecular features as well as current therapeutic approaches. We also explore emerging therapies and biomarkers aimed at improving outcomes for men with AIPC. RESULTS AND CONCLUSIONS Establishing consensus definitions, developing novel biomarkers for early and accurate detection, further characterization of molecular drivers of each phenotype, and developing effective therapies will be critical to improving outcomes for men with AIPC. Significant progress has been made toward defining the clinical and molecular characteristics of AVPC, NEPC, and DNPC. Novel diagnostic approaches, including cell-free DNA, circulating tumor cells, and molecular imaging are promising tools for detecting AIPC in clinical practice. Building on previous treatment advances, several clinical trials are underway evaluating novel therapeutic approaches in patients with AIPC informed by an understanding of variant-specific biology. In this review, we discuss how these recent and ongoing studies will help to improve diagnosis, prognosis, and therapy for men with AIPC.
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Affiliation(s)
- Jacob E Berchuck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Paul V Viscuse
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Himisha Beltran
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Moradi F, Farolfi A, Fanti S, Iagaru A. Prostate cancer: Molecular imaging and MRI. Eur J Radiol 2021; 143:109893. [PMID: 34391061 DOI: 10.1016/j.ejrad.2021.109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
The role of molecular imaging in initial evaluation of men with presumed or established diagnosis of prostate cancer and work up of biochemical recurrence and metastatic disease is rapidly evolving due to superior diagnostic performance compared to anatomic imaging. However, variable tumor biology and expression of transmembrane proteins or metabolic alterations poses a challenge. We review the evidence and controversies with emphasis on emerging PET radiopharmaceuticals and experience on clinical utility of PET/CT and PET/MRI in diagnosis and management of prostate cancer.
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Affiliation(s)
- Farshad Moradi
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA.
| | - Andrea Farolfi
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA
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27
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Shen K, Liu B, Zhou X, Ji Y, Chen L, Wang Q, Xue W. The Evolving Role of 18F-FDG PET/CT in Diagnosis and Prognosis Prediction in Progressive Prostate Cancer. Front Oncol 2021; 11:683793. [PMID: 34395251 PMCID: PMC8358601 DOI: 10.3389/fonc.2021.683793] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) is widely used in prostate cancer to evaluate the localized tumor burden and detect symptomatic metastatic lesions early. 18F-FDG is the most used tracer for oncologic imaging, but it has limitations in detecting early-stage prostate cancer. 68Ga-PSMA is a new tracer that has high specificity and sensibility in detecting local and metastatic tumors. But with the progression of prostate cancer, the enhancement of glucose metabolism in progressive prostate cancer provides a chance for 18F-FDG. This review focuses on PET/CT in the detection and prognosis of prostate cancer, summarizing the literature on 18F-FDG and 68Ga-PSMA in prostate cancer and highlighting that 18F-FDG has advantages in detecting local recurrence, visceral and lymph node metastases compared to 68Ga-PSMA in partial progressive prostate cancer and castration-resistant prostate cancer patients. We emphasize 18F-FDG PET/CT can compensate for the weakness of 68Ga-PSMA PET/CT in progressive prostate cancer.
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Affiliation(s)
- Kai Shen
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Liu
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Zhou
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyi Ji
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Chen
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Wang
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xue
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Li Z, He P, Long Y, Yuan G, Shen W, Chen Z, Zhang B, Wang Y, Yue D, Seidl C, Zhang X. Drug Repurposing of Pantoprazole and Vitamin C Targeting Tumor Microenvironment Conditions Improves Anticancer Effect in Metastatic Castration-Resistant Prostate Cancer. Front Oncol 2021; 11:660320. [PMID: 34307134 PMCID: PMC8294332 DOI: 10.3389/fonc.2021.660320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
The effective and economical therapeutic strategy for metastatic castration-resistant prostate cancer (mCRPC) is still requested from patients, who are not available for Lu-177 or Ra-223 treatment. Drug repurposing as a cost-effective and time-saving alternative to traditional drug development has been increasingly discussed. Proton pump inhibitors (PPIs) such as pantroprazole, which are commonly used as antacids, have also been shown to be effective in cancer chemoprevention via induction of apoptosis in multiple cancer cell lines. Vitamin C is an essential micronutrient for human body, has been proposed as a potential anti-cancer agent. In this context, have we investigated the combination of vitamin C and pantoprazole for the management of metastatic castration-resistant prostate cancer (mCRPC). Six chosen human adenocarcinoma cell lines were used to investigate the influence of pantoprazole on the microenvironment of cancer cells (extracellular pH and production of exosomes). Tumor growth and tumor 18F-FDG uptake in PC3 xenografts were analyzed following varied treatment. Our in vitro Results have suggested that pantoprazole enhanced the cytotoxic activity of vitamin C by regulating pH values and production of exosomes in cancer cells. Moreover, the synergistic effect of pantoprazole and vitamin C was pH-dependent since pantoprazole was more effective at a slightly acidic pH. In vivo, the combined treatment using pantoprazole and vitamin C produced better therapeutic outcomes than treatment with vitamin C or pantoprazole alone, as demonstrated via tumor growth and uptake of 18F-FDG. Therefore, we suggest that pantoprazole combined with vitamin C could be as a possible strategy to manage mCRPC.
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Affiliation(s)
- Zhoulei Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peng He
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yali Long
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gang Yuan
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wanqing Shen
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhifeng Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bing Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yue Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dianchao Yue
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Christof Seidl
- Department of Nuclear Medicine, Klinikumrechts der Isar, Technical University Munich, Munich, Germany
| | - Xiangsong Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Hyväkkä A, Virtanen V, Kemppainen J, Grönroos TJ, Minn H, Sundvall M. More Than Meets the Eye: Scientific Rationale behind Molecular Imaging and Therapeutic Targeting of Prostate-Specific Membrane Antigen (PSMA) in Metastatic Prostate Cancer and Beyond. Cancers (Basel) 2021; 13:cancers13092244. [PMID: 34067046 PMCID: PMC8125679 DOI: 10.3390/cancers13092244] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Prostate-specific membrane antigen (PSMA) is a transmembrane protein that is overexpressed in prostate cancer and correlates with the aggressiveness of the disease. PSMA is a promising target for imaging and therapeutics in prostate cancer patients validated in prospective trials. However, the role of PSMA in prostate cancer progression is poorly understood. In this review, we discuss the biology and scientific rationale behind the use of PSMA and other targets in the detection and theranostics of metastatic prostate cancer. Abstract Prostate cancer is the second most common cancer type in men globally. Although the prognosis for localized prostate cancer is good, no curative treatments are available for metastatic disease. Better diagnostic methods could help target therapies and improve the outcome. Prostate-specific membrane antigen (PSMA) is a transmembrane glycoprotein that is overexpressed on malignant prostate tumor cells and correlates with the aggressiveness of the disease. PSMA is a clinically validated target for positron emission tomography (PET) imaging-based diagnostics in prostate cancer, and during recent years several therapeutics have been developed based on PSMA expression and activity. The expression of PSMA in prostate cancer can be very heterogeneous and some metastases are negative for PSMA. Determinants that dictate clinical responses to PSMA-targeting therapeutics are not well known. Moreover, it is not clear how to manipulate PSMA expression for therapeutic purposes and develop rational treatment combinations. A deeper understanding of the biology behind the use of PSMA would help the development of theranostics with radiolabeled compounds and other PSMA-based therapeutic approaches. Along with PSMA several other targets have also been evaluated or are currently under investigation in preclinical or clinical settings in prostate cancer. Here we critically elaborate the biology and scientific rationale behind the use of PSMA and other targets in the detection and therapeutic targeting of metastatic prostate cancer.
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Affiliation(s)
- Anniina Hyväkkä
- Institute of Biomedicine, Cancer Research Unit, FICAN West Cancer Center Laboratory, University of Turku and Turku University Hospital, FI-20520 Turku, Finland; (A.H.); (V.V.)
| | - Verneri Virtanen
- Institute of Biomedicine, Cancer Research Unit, FICAN West Cancer Center Laboratory, University of Turku and Turku University Hospital, FI-20520 Turku, Finland; (A.H.); (V.V.)
- Turku Doctoral Programme of Molecular Medicine (TuDMM), University of Turku, FI-20520 Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku, FI-20521 Turku, Finland;
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, FI-20521 Turku, Finland
- Docrates Cancer Center, FI-00180 Helsinki, Finland
| | - Tove J. Grönroos
- Preclinical Imaging Laboratory, Turku PET Centre, University of Turku, FI-20520 Turku, Finland;
| | - Heikki Minn
- Department of Oncology, FICAN West Cancer Center, University of Turku and Turku University Hospital, FI-20521 Turku, Finland;
| | - Maria Sundvall
- Institute of Biomedicine, Cancer Research Unit, FICAN West Cancer Center Laboratory, University of Turku and Turku University Hospital, FI-20520 Turku, Finland; (A.H.); (V.V.)
- Department of Oncology, FICAN West Cancer Center, University of Turku and Turku University Hospital, FI-20521 Turku, Finland;
- Correspondence:
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30
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Abiodun-Ojo OA, Akintayo AA, Harik LR, Bilen M, Halkar RK. Poorly Differentiated Neuroendocrine Tumor With 18F-Fluciclovine Uptake in a Patient With Metastatic Castrate-Resistant Prostate Cancer. Clin Nucl Med 2021; 46:e282-e285. [PMID: 33208627 DOI: 10.1097/rlu.0000000000003408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT 18F-Fluciclovine is an amino acid-based radiopharmaceutical used primarily for PET imaging of patients with biochemical recurrence of prostate cancer. We report a case of a 66-year-old man with recently diagnosed metastatic castrate-resistant prostate cancer and a left supraclavicular lymph node with incidental radiotracer uptake on 18F-fluciclovine PET/CT. Left neck core needle biopsy confirmed high-grade, poorly differentiated carcinoma with neuroendocrine features positive for synaptophysin and chromogranin, and negative for prostate markers.
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Affiliation(s)
| | | | - Lara R Harik
- Pathology and Laboratory Medicine, Emory University School of Medicine
| | - Mehmet Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, GA
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31
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Undesirable Status of Prostate Cancer Cells after Intensive Inhibition of AR Signaling: Post-AR Era of CRPC Treatment. Biomedicines 2021; 9:biomedicines9040414. [PMID: 33921329 PMCID: PMC8069212 DOI: 10.3390/biomedicines9040414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
Recent advances in prostate cancer (PC) research unveiled real androgen receptor (AR) functions in castration-resistant PC (CRPC). Moreover, AR still accelerates PC cell proliferation via the activation of several mechanisms (e.g., mutation, variants, and amplifications in CRPC). New-generation AR signaling-targeted agents, inhibiting extremely the activity of AR, were developed based on these incontrovertible mechanisms of AR-induced CRPC progression. However, long-term administration of AR signaling-targeted agents subsequently induces the major problem that AR (complete)-independent CRPC cells present neither AR nor prostate-specific antigen, including neuroendocrine differentiation as a subtype of AR-independent CRPC. Moreover, there are few treatments effective for AR-independent CRPC with solid evidence. This study focuses on the transformation mechanisms of AR-independent from AR-dependent CRPC cells and potential treatment strategy for AR-independent CRPC and discusses them based on a review of basic and clinical literature.
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32
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Kitajima K, Yamamoto S, Ikeda M, Yamasaki T, Kawanaka Y, Komoto H, Maruyama M, Nishizaki K, Kimura K, Kimura N, Yamakado K. Pelvic MRI, FDG-PET/CT, and Somatostatin Receptor Scintigraphy Findings of Treatment-Related Neuroendocrine-Differentiated Prostate Cancer. Case Rep Oncol 2021; 14:397-402. [PMID: 33776735 PMCID: PMC7983583 DOI: 10.1159/000511070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 11/19/2022] Open
Abstract
Treatment-related neuroendocrine-differentiated prostate cancer (NEPC) is a rare tumor entity that transdifferentiates from adenocarcinoma as an adaptive response to androgen receptor pathway inhibition. We report a 79-year-old male with treatment-related NEPC, presenting as rectal bleeding after hormonal therapy. MRI showed a 51 × 52 × 65 mm tumor occupying almost the whole prostate gland and invading the seminal vesicle and rectum as moderately heterogeneous hypointensity on T2-weighted image, restricted diffusion on apparent diffusion coefficient map and diffusion-weighted imaging, and heterogeneous enhancement on Gd-enhanced T1-weighted image. FDG-PET/CT showed strong FDG uptake of the prostate tumor, and somatostatin receptor scintigraphy (SRS) showed mild uptake of the prostate tumor. The surgically resected specimen revealed NEPC. If prostate cancer worsens despite conventional therapy, treatment-related NEPC should be considered, and the benefit of imaging examinations including prostate MRI, FDG-PET/CT, and SRS is in localizing lesions with neuroendocrine differentiation.
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Affiliation(s)
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
| | - Masataka Ikeda
- Division Lower GI, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Yamasaki
- Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan
| | - Yusuke Kawanaka
- Department of Radiology, Hyogo College of Medicine, Hyogo, Japan
| | - Hisashi Komoto
- Department of Radiology, Hyogo College of Medicine, Hyogo, Japan
| | | | | | - Kei Kimura
- Division Lower GI, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Neinei Kimura
- Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan
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Kurashina R, Kijima T, Okazaki A, Fuchizawa H, Suzuki I, Sakamoto K, Betsunoh H, Fukabori Y, Yashi M, Kamai T. Utility of whole-body diffusion-weighted magnetic resonance imaging in the management of treatment-related neuroendocrine prostate cancer. IJU Case Rep 2021; 4:69-73. [PMID: 33718807 PMCID: PMC7924092 DOI: 10.1002/iju5.12242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Treatment-related neuroendocrine prostate cancer, a rare and aggressive malignancy that emerges during androgen deprivation therapy characterized by low serum prostate-specific antigen concentrations, is challenging to monitor because it is associated with predominantly visceral and lytic bone metastases. CASE PRESENTATION We describe the case of a 69-year-old man with treatment-related neuroendocrine prostate cancer in whom the treatment response could be monitored using whole-body diffusion-weighted magnetic resonance imaging in addition to serum concentrations of neuroendocrine markers. The patient responded well to platinum-based chemotherapy and achieved a complete response, as evidenced by these diagnostic modalities. CONCLUSION Our case suggests that whole-body diffusion-weighted magnetic resonance imaging is useful in disease management for treatment-related neuroendocrine prostate cancer as well as the potential evaluation of mixed responses and treatment resistance.
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Affiliation(s)
- Ryo Kurashina
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | - Toshiki Kijima
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | | | | | - Issei Suzuki
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | | | | | | | - Masahiro Yashi
- Department of UrologyDokkyo Medical UniversityTochigiJapan
| | - Takao Kamai
- Department of UrologyDokkyo Medical UniversityTochigiJapan
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34
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Iravani A, Mitchell C, Akhurst T, Sandhu S, Hofman MS, Hicks RJ. Molecular Imaging of Neuroendocrine Differentiation of Prostate Cancer: A Case Series. Clin Genitourin Cancer 2021; 19:e200-e205. [PMID: 33678552 DOI: 10.1016/j.clgc.2021.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Amir Iravani
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Catherine Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Tim Akhurst
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Shahneen Sandhu
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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Uo T, Sprenger CC, Plymate SR. Androgen Receptor Signaling and Metabolic and Cellular Plasticity During Progression to Castration Resistant Prostate Cancer. Front Oncol 2020; 10:580617. [PMID: 33163409 PMCID: PMC7581990 DOI: 10.3389/fonc.2020.580617] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/25/2020] [Indexed: 12/14/2022] Open
Abstract
Metabolic reprogramming is associated with re/activation and antagonism of androgen receptor (AR) signaling that drives prostate cancer (PCa) progression to castration resistance, respectively. In particular, AR signaling influences the fates of citrate that uniquely characterizes normal and malignant prostatic metabolism (i.e., mitochondrial export and extracellular secretion in normal prostate, mitochondrial retention and oxidation to support oxidative phenotype of primary PCa, and extra-mitochondrial interconversion into acetyl-CoA for fatty acid synthesis and epigenetics in the advanced PCa). The emergence of castration-resistant PCa (CRPC) involves reactivation of AR signaling, which is then further targeted by androgen synthesis inhibitors (abiraterone) and AR-ligand inhibitors (enzalutamide, apalutamide, and daroglutamide). However, based on AR dependency, two distinct metabolic and cellular adaptations contribute to development of resistance to these agents and progression to aggressive and lethal disease, with the tumor ultimately becoming highly glycolytic and with imaging by a tracer of tumor energetics, 18F-fluorodoxyglucose (18F-FDG). Another major resistance mechanism involves a lineage alteration into AR-indifferent carcinoma such a neuroendocrine which is diagnostically characterized by robust 18F-FDG uptake and loss of AR signaling. PCa is also characterized by metabolic alterations such as fatty acid and polyamine metabolism depending on AR signaling. In some cases, AR targeting induces rather than suppresses these alterations in cellular metabolism and energetics, which can be explored as therapeutic targets in lethal CRPC.
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Affiliation(s)
- Takuma Uo
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Cynthia C Sprenger
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Stephen R Plymate
- Department of Medicine, University of Washington, Seattle, WA, United States.,Geriatrics Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
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36
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Mason BR, Eastham JA, Davis BJ, Mynderse LA, Pugh TJ, Lee RJ, Ippolito JE. Current Status of MRI and PET in the NCCN Guidelines for Prostate Cancer. J Natl Compr Canc Netw 2020; 17:506-513. [PMID: 31085758 DOI: 10.6004/jnccn.2019.7306] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/29/2019] [Indexed: 11/17/2022]
Abstract
Prostate cancer (PCa) represents a significant source of morbidity and mortality for men in the United States, with approximately 1 in 9 being diagnosed with PCa in their lifetime. The role of imaging in the evaluation of men with PCa has evolved and currently plays a central role in diagnosis, treatment planning, and evaluation of recurrence. Appropriate use of multiparametric MRI (mpMRI) and MRI-guided transrectal ultrasound (MR-TRUS) biopsy increases the detection of clinically significant PCa while decreasing the detection of clinically insignificant PCa. This process may help patients with clinically insignificant PCa avoid the adverse effects of unnecessary therapy. In the setting of a known PCa, patients with low-grade disease can be observed using active surveillance, which often includes a combination of prostate-specific antigen (PSA) testing, serial mpMRI, and, if indicated, follow-up systematic and targeted TRUS-guided tissue sampling. mpMRI can provide important information in the posttreatment setting, but PET/CT is creating a paradigm shift in imaging standards for patients with locally recurrent and metastatic PCa. This article examines the strengths and limitations of mpMRI for initial PCa diagnosis, active surveillance, recurrent disease evaluation, and image-guided biopsies, and the use of PET/CT imaging in men with recurrent PCa. The goal of this review is to provide a rational basis for current NCCN Clinical Practice Guidelines in Oncology for PCa as they pertain to the use of these advanced imaging modalities.
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Affiliation(s)
- Brandon R Mason
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado, Denver, Colorado; and
| | - Richard J Lee
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Rosar F, Ribbat K, Ries M, Linxweiler J, Bartholomä M, Maus S, Schreckenberger M, Ezziddin S, Khreish F. Neuron-specific enolase has potential value as a biomarker for [ 18F]FDG/[ 68Ga]Ga-PSMA-11 PET mismatch findings in advanced mCRPC patients. EJNMMI Res 2020; 10:52. [PMID: 32449086 PMCID: PMC7246282 DOI: 10.1186/s13550-020-00640-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND PSMA-targeted radioligand therapy (PSMA-RLT) yielded impressive results in the metastasized castration-resistant prostate carcinoma (mCRPC) setting. High expression of PSMA is essential for successful PSMA-RLT. However, some patients develop [18F]FDG-avid lesions with low or no PSMA expression ([18F]FDG/[68Ga]Ga-PSMA-11 mismatch findings on PET/CT) in the course of treatment. Those lesions are not affected by PSMA-RLT and a change in therapy management is needed. To enable early mismatch detection, possible blood parameters as indicators for the occurrence of [18F]FDG/[68Ga]Ga-PSMA-11 mismatch findings on PET/CT were evaluated. METHODS Retrospective study of N = 66 advanced mCRPC patients with dual [68Ga]Ga-PSMA-11 and [18F]FDG PET/CT imaging within 4 weeks, who were referred for or received [177Lu]Lu-PSMA-617 radioligand therapy. Prostate-specific antigen (PSA), neuron-specific enolase (NSE), gamma-glutamyltransferase (GGT), and alkaline phosphatase (ALP) were tested as indicators for the occurrence of [18F]FDG/[68Ga]Ga-PSMA-11 mismatch findings. Additional to absolute values, relative changes (ΔPSA, ΔNSE, ΔGGT, ΔALP) over a period of 4 ± 1 weeks prior to [18F]FDG PET/CT were analyzed. RESULTS In total, 41/66 (62%) patients revealed at least one [18F]FDG/[68Ga]Ga-PSMA-11 mismatch finding on PET/CT. These mismatch findings were detected in 13/41 (32%) patients by screening for and in 28/41 (68%) patients during PSMA-RLT. NSE serum level (55.4 ± 44.6 μg/l vs. 18.5 ± 8 μg/l, p < 0.001) and ΔNSE (93.8 ± 124.5% vs. 2.9 ± 39.5%, p < 0.001) were significantly higher in the mismatch group than in the non-mismatch group. No significant differences were found for serum PSA (p = 0.424), ΔPSA (p = 0.417), serum ALP (p = 0.937), ΔALP (p = 0.611), serum GGT (p = 0.773), and ΔGGT (p = 0.971). For NSE and ΔNSE, the maximum value of the Youden index in ROC analysis was at a cut-off level of 26.8 μg/l (sensitivity 78%, specificity 96%) and at + 13.9% (sensitivity 84%, specificity 75%), respectively. An introduced scoring system of both parameters achieved a sensitivity of 90% and a specificity of 88% for the occurrence of [18F]FDG/[68Ga]Ga-PSMA-11 mismatch. CONCLUSION We observed a significantly higher absolute serum concentration and a higher relative increase of NSE in advanced mCRPC patients with [18F]FDG-avid and insufficient PSMA expressing metastases ([18F]FDG/[68Ga]Ga-PSMA-11 mismatch findings on PET/CT) in our cohort. NSE might be used as a potential laboratory indicator for [18F]FDG/[68Ga]Ga-PSMA-11 mismatch findings, if this observation is confirmed in future, ideally prospective, studies in larger patient cohorts.
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Affiliation(s)
- Florian Rosar
- Department of Nuclear Medicine, Saarland University-Medical Center, Kirrberger Str. 100, Geb. 50, 66421, Homburg, Germany.
| | - Kalle Ribbat
- Department of Nuclear Medicine, Saarland University-Medical Center, Kirrberger Str. 100, Geb. 50, 66421, Homburg, Germany
| | - Martin Ries
- Department of Nuclear Medicine, Saarland University-Medical Center, Kirrberger Str. 100, Geb. 50, 66421, Homburg, Germany
| | | | - Mark Bartholomä
- Department of Nuclear Medicine, Saarland University-Medical Center, Kirrberger Str. 100, Geb. 50, 66421, Homburg, Germany
| | - Stephan Maus
- Department of Nuclear Medicine, Saarland University-Medical Center, Kirrberger Str. 100, Geb. 50, 66421, Homburg, Germany
| | | | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University-Medical Center, Kirrberger Str. 100, Geb. 50, 66421, Homburg, Germany
| | - Fadi Khreish
- Department of Nuclear Medicine, Saarland University-Medical Center, Kirrberger Str. 100, Geb. 50, 66421, Homburg, Germany
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Mannas MP, Lee T, Pourghiasian M, Wilson DC, Black PC. Incidentalomas of the prostate detected by 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography. Can Urol Assoc J 2020; 14:E180-E184. [PMID: 31793859 PMCID: PMC7197962 DOI: 10.5489/cuaj.5976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Prostate incidentalomas are prostatic lesions suspicious for cancer discovered by imaging patients without a known history of prostatic cancer (PCa) for other reasons. 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET) is used to diagnose, stage, and assess response to treatment for numerous cancers, but it is not routinely used for PCa. We aimed to determine the rate of detection of prostate incidentalomas in patients undergoing FDG PET and to evaluate the natural history of these lesions. METHODS A retrospective review was conducted of all FDG PET scans performed between 2005 and 2017 at a single institution. Patients were selected who had prostatic uptake without a history of PCa. Clinical data were collected from electronic medical records to determine how the prostate incidentalomas were further evaluated and to define the rate of malignancy. RESULTS A prostate incidentaloma was identified in 309 (1.0%) of 31 019 FDG PET scans performed on men. A prostate-specific antigen (PSA) test was obtained in 40.1% of patients within six months of prostate incidentaloma detection. Six patients underwent a multiparametric magnetic resonance imaging (mpMRI) of the prostate, which identified PCa in one case. Overall, PCa was diagnosed in 33 cases, representing 10.7% of the prostate incidentalomas and 0.1% of the scanned patients. PCa was intermediate- or high-risk in 27 (8.7%) of the prostate incidentalomas. CONCLUSIONS Incidental lesions detected in the prostate by FDG PET may represent clinically significant PCa. Referral to a urologist for further evaluation should be considered if the patient is otherwise in reasonable health.
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Affiliation(s)
- Miles P Mannas
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
| | - Taeweon Lee
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
| | - Maral Pourghiasian
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
| | - Don C Wilson
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
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Bader DA, McGuire SE. Tumour metabolism and its unique properties in prostate adenocarcinoma. Nat Rev Urol 2020; 17:214-231. [PMID: 32112053 DOI: 10.1038/s41585-020-0288-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
Abstract
Anabolic metabolism mediated by aberrant growth factor signalling fuels tumour growth and progression. The first biochemical descriptions of the altered metabolic nature of solid tumours were reported by Otto Warburg almost a century ago. Now, the study of tumour metabolism is being redefined by the development of new molecular tools, tumour modelling systems and precise instrumentation together with important advances in genetics, cell biology and spectroscopy. In contrast to Warburg's original hypothesis, accumulating evidence demonstrates a critical role for mitochondrial metabolism and substantial variation in the way in which different tumours metabolize nutrients to generate biomass. Furthermore, computational and experimental approaches suggest a dominant influence of the tissue-of-origin in shaping the metabolic reprogramming that enables tumour growth. For example, the unique metabolic properties of prostate adenocarcinoma are likely to stem from the distinct metabolism of the prostatic epithelium from which it emerges. Normal prostatic epithelium employs comparatively glycolytic metabolism to sustain physiological citrate secretion, whereas prostate adenocarcinoma consumes citrate to power oxidative phosphorylation and fuel lipogenesis, enabling tumour progression through metabolic reprogramming. Current data suggest that the distinct metabolic aberrations in prostate adenocarcinoma are driven by the androgen receptor, providing opportunities for functional metabolic imaging and novel therapeutic interventions that will be complementary to existing diagnostic and treatment options.
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Affiliation(s)
- David A Bader
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA. .,Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA.
| | - Sean E McGuire
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA. .,Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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40
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Meziou S, Ringuette Goulet C, Hovington H, Lefebvre V, Lavallée É, Bergeron M, Brisson H, Champagne A, Neveu B, Lacombe D, Beauregard JM, Buteau FA, Riopel J, Pouliot F. GLUT1 expression in high-risk prostate cancer: correlation with 18F-FDG-PET/CT and clinical outcome. Prostate Cancer Prostatic Dis 2020; 23:441-448. [PMID: 31932660 DOI: 10.1038/s41391-020-0202-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Tumour 18F-FDG-uptake is of prognostic value in high-risk and metastatic prostate cancer (PCa). The aim of this study is to investigate the underlying glucose metabolism mechanisms of 18F-FDG-uptake on PET/CT imaging in PCa. METHODS Retrospective analysis was conducted for 94 patients diagnosed with a Gleason sum ≥8 adenocarcinoma of the prostate at biopsy between July 2011 and July 2014 who underwent 18F-FDG-PET/CT imaging before radical prostatectomy (RP). 18F-FDG-uptake in primary lesion was measured by a blinded reader using maximum standardised uptake value (SUVmax). GLUT1, GLUT12 and HK2 expression were blindly scored after immunohistochemistry on specimens RP by three pathologists. Correlations between GLUT1, GLUT12 and HK2, and SUVmax were assessed using Spearman's rank correlation test. Survival probabilities were based on the Kaplan-Meier method. RESULTS With a median follow-up of 4.5 years, 56% (n = 53) of patients had biochemical recurrence (BCR), 7% (n = 7) progressed to castration-resistant prostate cancer (CRPC) disease, 13% (n = 12) developed metastasis and 6% (n = 6) died. Correlation was found between GLUT1 expression and SUVmax level (r = 0.25, p = 0.02). In addition, SUVmax was significantly higher in tumours with high GLUT1 expression (n = 17, 5.74 ± 1.67) than tumours with low GLUT1 expression (n = 71, 2.68 ± 0.31, p = 0.004). Moreover, a significant association was found between GLUT1 expression levels and SUVmax level (p = 0.005), lymph node status (p = 0.05), volume of cancer (p = 0.01), CRPC disease progression (p = 0.02) and metastasis development (p = 0.04). No significant difference between GLUT12 and HEX2 expression and SUVmax have been found. CONCLUSIONS GLUT1 expression in PCa tumours correlates with 18F-FDG-uptake and poor prognostic factors. These results suggest that this transporter is involved in the molecular mechanism of 18F-FDG-uptake in high-risk PCa and raise interest in targeting metabolic dependencies of PCa cells as a selective anticancer strategy.
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Affiliation(s)
- Salma Meziou
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Pathology, CHU de Québec, Québec, QC, Canada
| | - Cassandra Ringuette Goulet
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Hélène Hovington
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | | | - Étienne Lavallée
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Michelle Bergeron
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Hervé Brisson
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Audrey Champagne
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Bertrand Neveu
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Didier Lacombe
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Jean-Mathieu Beauregard
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Québec, QC, Canada
| | - François-Alexandre Buteau
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Québec, QC, Canada.,Department of Medical Imaging, CHU de Québec, Québec, QC, Canada
| | - Julie Riopel
- Department of Pathology, CHU de Québec, Québec, QC, Canada
| | - Frédéric Pouliot
- Urology Division, CHU de Québec Research Center, Québec, QC, Canada. .,Department of Surgery, Faculty of Medicine, Laval University, Québec, QC, Canada.
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Bakht MK, Lovnicki JM, Tubman J, Stringer KF, Chiaramonte J, Reynolds MR, Derecichei I, Ferraiuolo RM, Fifield BA, Lubanska D, Oh SW, Cheon GJ, Kwak C, Jeong CW, Kang KW, Trant JF, Morrissey C, Coleman IM, Wang Y, Ahmadzadehfar H, Dong X, Porter LA. Differential Expression of Glucose Transporters and Hexokinases in Prostate Cancer with a Neuroendocrine Gene Signature: A Mechanistic Perspective for 18F-FDG Imaging of PSMA-Suppressed Tumors. J Nucl Med 2019; 61:904-910. [PMID: 31806771 DOI: 10.2967/jnumed.119.231068] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022] Open
Abstract
Although the incidence of de novo neuroendocrine prostate cancer (PC) is rare, recent data suggest that low expression of prostate-specific membrane antigen (PSMA) is associated with a spectrum of neuroendocrine hallmarks and androgen receptor (AR) suppression in PC. Previous clinical reports indicate that PCs with a phenotype similar to neuroendocrine tumors can be more amenable to imaging by 18F-FDG than by PSMA-targeting radioligands. In this study, we evaluated the association between neuroendocrine gene signature and 18F-FDG uptake-associated genes including glucose transporters (GLUTs) and hexokinases, with the goal of providing a genomic signature to explain the reported 18F-FDG avidity of PSMA-suppressed tumors. Methods: Data-mining approaches, cell lines, and patient-derived xenograft models were used to study the levels of 14 members of the SLC2A family (encoding GLUT proteins), 4 members of the hexokinase family (genes HK1-HK3 and GCK), and PSMA (FOLH1 gene) after AR inhibition and in correlation with neuroendocrine hallmarks. Also, we characterize a neuroendocrine-like PC (NELPC) subset among a cohort of primary and metastatic PC samples with no neuroendocrine histopathology. We measured glucose uptake in a neuroendocrine-induced in vitro model and a zebrafish model by nonradioactive imaging of glucose uptake using a fluorescent glucose bioprobe, GB2-Cy3. Results: This work demonstrated that a neuroendocrine gene signature associates with differential expression of genes encoding GLUT and hexokinase proteins. In NELPC, elevated expression of GCK (encoding glucokinase protein) and decreased expression of SLC2A12 correlated with earlier biochemical recurrence. In tumors treated with AR inhibitors, high expression of GCK and low expression of SLC2A12 correlated with neuroendocrine histopathology and PSMA gene suppression. GLUT12 suppression and upregulation of glucokinase were observed in neuroendocrine-induced PC cell lines and patient-derived xenograft models. A higher glucose uptake was confirmed in low-PSMA tumors using a GB2-Cy3 probe in a zebrafish model. Conclusion: A neuroendocrine gene signature in neuroendocrine PC and NELPC associates with a distinct transcriptional profile of GLUTs and hexokinases. PSMA suppression correlates with GLUT12 suppression and glucokinase upregulation. Alteration of 18F-FDG uptake-associated genes correlated positively with higher glucose uptake in AR- and PSMA-suppressed tumors. Zebrafish xenograft tumor models are an accurate and efficient preclinical method for monitoring nonradioactive glucose uptake.
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Affiliation(s)
- Martin K Bakht
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada.,Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jessica M Lovnicki
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice Tubman
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
| | - Keith F Stringer
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada.,Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan Chiaramonte
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario, Canada
| | - Michael R Reynolds
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario, Canada
| | - Iulian Derecichei
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
| | | | - Bre-Anne Fifield
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
| | - Dorota Lubanska
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
| | - So Won Oh
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea .,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - John F Trant
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario, Canada
| | - Colm Morrissey
- Department of Urology, University of Washington, Seattle, Washington
| | - Ilsa M Coleman
- Divison of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; and
| | - Yuzhuo Wang
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Xuesen Dong
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa A Porter
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
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Mortensen MA, Poulsen MH, Gerke O, Jakobsen JS, Høilund-Carlsen PF, Lund L. 18F-Fluoromethylcholine-positron emission tomography/computed tomography for diagnosing bone and lymph node metastases in patients with intermediate- or high-risk prostate cancer. Prostate Int 2019; 7:119-123. [PMID: 31485437 PMCID: PMC6713799 DOI: 10.1016/j.prnil.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/26/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Background The use of molecular imaging in staging of prostate cancer (PC) is debated. In patients with newly diagnosed PC we investigated the diagnostic value of 18F-flouromethylcholine positron emission tomography/computed tomography (18F-FCH-PET/CT) for the detection of bone and lymph node metastases compared to whole-body bone scintigraphy (WBS) with technetium-99-methylene diphosphonate (99mTc-MDP) and results of extended pelvic lymph node dissection, respectively. Materials and methods Between January 2013 and April 2016, 143 patients, aged 49-83, mean 69, years with newly diagnosed PC and disease characteristics necessitating WBS underwent both WBS and 18F-FCH-PET/CT using magnetic resonance imaging as standard. Eighty of these patients underwent pelvic lymph node dissection as part of radical prostatectomy or prior to external beam radiation and in these results of 18F-FCH-PET/CT were compared to histologic findings. Results Bone metastases were detected in 8/143 patients and sensitivity and specificity of WBS were 37.5% and 85.2% versus 100.0% and 96.3% with 18F-FCH-PET/CT, P=0.63 and 0.002, respectively. Histologically confirmed metastases to regional lymph nodes were found in 25/80 patients. Suspicious choline uptake on PET/CT in pelvic lymph nodes was found in 35 patients. Sensitivity, specificity, PPV, NPV and accuracy of 18F-FCH-PET/CT in detection of lymph node metastases were 62.5%, 69.6%, 46.9%, 81.3% and 67.5%, respectively. Conclusions Findings in this study suggested that 18F-FCH-PET/CT is a more sensitive and specific method for detection of bone metastases from PC than WBS and could potentially reduce the need for confirmatory imaging if used instead of WBS. However, 18F-FCH-PET/CT performs sub-optimally in pre-operative staging of lymph node metastases in patients undergoing extended pelvic lymph node dissection.
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Affiliation(s)
- Mike Allan Mortensen
- Department of Urology, Odense University Hospital, Odense, Denmark
- Corresponding author. Department of Urology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000 Odense, Denmark.
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | | | | | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
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43
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18F-FDG, 68Ga-DOTATATE and 68Ga-PSMA Positive Metastatic Large Cell Neuroendocrine Prostate Tumor. Clin Nucl Med 2019; 44:53-54. [PMID: 30325820 DOI: 10.1097/rlu.0000000000002322] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prostate large cell neuroendocrine tumor is a rare disease. In this case, metastatic areas showing FDG uptake, somatostatin receptor positivity, and PSMA expression are shown in F-FDG PET/CT, Ga-DOTATATE PET/CT, and Ga-PSMA PET/CT in a 70-year-old man with the diagnosis of prostate large cell neuroendocrine carcinoma.
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45
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Multiple intraparenchymal cystic brain metastases - a rare manifestation of metastatic adenocarcinoma of the prostate. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2018.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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46
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Beuthien-Baumann B, Koerber SA. PET imaging in adaptive radiotherapy of prostate tumors. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:404-410. [DOI: 10.23736/s1824-4785.18.03080-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mori H, Nakajima K, Kadomoto S, Mizokami A, Ikeda H, Wakabayashi H, Kinuya S. Imaging Somatostatin Receptor Activity in Neuroendocrine-differentiated Prostate Cancer. Intern Med 2018; 57:3123-3128. [PMID: 29877274 PMCID: PMC6262717 DOI: 10.2169/internalmedicine.0630-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neuroendocrine-differentiated prostate cancer (NEPC) is a rare pathophysiology. We herein report a patient diagnosed with conventional prostate adenocarcinoma before hormone therapy, which was later diagnosed as NEPC. The nadir of prostate-specific antigen (PSA) was achieved once. However, adenocarcinoma changed to NEPC in recurrence, and the serum progastrin-releasing peptide (Pro-GRP) and neuron-specific enolase (NSE) values increased. A prostate needle biopsy revealed neuroendocrine differentiation. The chemotherapy regimen was changed, and somatostatin receptor scintigraphy (SRS) helped to determine the distribution and features of lesions as well as the effects of therapy. When prostate cancer worsens despite conventional therapy, NEPC should be considered.
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Affiliation(s)
- Hiroshi Mori
- Department of Nuclear Medicine, Kanazawa University, Japan
| | | | | | | | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University, Japan
| | | | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University, Japan
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48
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Flores-Morales A, Bergmann TB, Lavallee C, Batth TS, Lin D, Lerdrup M, Friis S, Bartels A, Kristensen G, Krzyzanowska A, Xue H, Fazli L, Hansen KH, Røder MA, Brasso K, Moreira JM, Bjartell A, Wang Y, Olsen JV, Collins CC, Iglesias-Gato D. Proteogenomic Characterization of Patient-Derived Xenografts Highlights the Role of REST in Neuroendocrine Differentiation of Castration-Resistant Prostate Cancer. Clin Cancer Res 2018; 25:595-608. [PMID: 30274982 DOI: 10.1158/1078-0432.ccr-18-0729] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/04/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE An increasing number of castration-resistant prostate cancer (CRPC) tumors exhibit neuroendocrine (NE) features. NE prostate cancer (NEPC) has poor prognosis, and its development is poorly understood.Experimental Design: We applied mass spectrometry-based proteomics to a unique set of 17 prostate cancer patient-derived xenografts (PDX) to characterize the effects of castration in vivo, and the proteome differences between NEPC and prostate adenocarcinomas. Genome-wide profiling of REST-occupied regions in prostate cancer cells was correlated to the expression changes in vivo to investigate the role of the transcriptional repressor REST in castration-induced NEPC differentiation. RESULTS An average of 4,881 proteins were identified and quantified from each PDX. Proteins related to neurogenesis, cell-cycle regulation, and DNA repair were found upregulated and elevated in NEPC, while the reduced levels of proteins involved in mitochondrial functions suggested a prevalent glycolytic metabolism of NEPC tumors. Integration of the REST chromatin bound regions with expression changes indicated a direct role of REST in regulating neuronal gene expression in prostate cancer cells. Mechanistically, depletion of REST led to cell-cycle arrest in G1, which could be rescued by p53 knockdown. Finally, the expression of the REST-regulated gene secretagogin (SCGN) correlated with an increased risk of suffering disease relapse after radical prostatectomy. CONCLUSIONS This study presents the first deep characterization of the proteome of NEPC and suggests that concomitant inhibition of REST and the p53 pathway would promote NEPC. We also identify SCGN as a novel prognostic marker in prostate cancer.
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Affiliation(s)
- Amilcar Flores-Morales
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tobias B Bergmann
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society, Copenhagen, Denmark
| | - Charlotte Lavallee
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society, Copenhagen, Denmark
| | - Tanveer S Batth
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dong Lin
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mads Lerdrup
- Biotech Research and Innovation Center, University of Copenhagen, Copenhagen, Denmark
| | - Stine Friis
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society, Copenhagen, Denmark
| | - Anette Bartels
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society, Copenhagen, Denmark
| | - Gitte Kristensen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Agnieszka Krzyzanowska
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Lund, Sweden
| | - Hui Xue
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ladan Fazli
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Klaus H Hansen
- Biotech Research and Innovation Center, University of Copenhagen, Copenhagen, Denmark
| | - Martin A Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - José M Moreira
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society, Copenhagen, Denmark
| | - Anders Bjartell
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Lund, Sweden
| | - Yuzhuo Wang
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesper V Olsen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Colin C Collins
- Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diego Iglesias-Gato
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- The Danish Cancer Society, Copenhagen, Denmark
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49
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Evans JD, Jethwa KR, Ost P, Williams S, Kwon ED, Lowe VJ, Davis BJ. Prostate cancer–specific PET radiotracers: A review on the clinical utility in recurrent disease. Pract Radiat Oncol 2018; 8:28-39. [DOI: 10.1016/j.prro.2017.07.011] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 01/08/2023]
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50
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Yossi S, Brahmi T, Enachescu C, Selmaji I, Lapierre A, Samlali H, Chapet O. [Management of neuroendocrine prostate carcinoma: Literature review]. Cancer Radiother 2016; 20:330-5. [PMID: 27340027 DOI: 10.1016/j.canrad.2016.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/02/2016] [Accepted: 02/24/2016] [Indexed: 10/21/2022]
Abstract
Neuroendocrine prostate carcinoma is a rare entity causing both diagnostic and therapeutic issues. There are basically four histological forms (adenocarcinoma with neuroendocrine differentiation, carcinoid tumors, small cell neuroendocrine carcinomas, large cell neuroendocrine carcinomas), which can be pure or mixed associated with prostatic carcinoma. There is no consensus on the management or the prognosis of these various tumor subtypes. We conducted a literature review aiming to determine the potential therapeutic implications.
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Affiliation(s)
- S Yossi
- Département de radiothérapie, CHU Lyon Sud, 195, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - T Brahmi
- Département de radiothérapie, CHU Lyon Sud, 195, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - C Enachescu
- Département de radiothérapie, CHU Lyon Sud, 195, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - I Selmaji
- Département de radiothérapie, CHU Lyon Sud, 195, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Département de radiothérapie, CHU de Marrakech, Marrakech, Maroc
| | - A Lapierre
- Département de radiothérapie, CHU Lyon Sud, 195, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - H Samlali
- Département de radiothérapie, CHU Lyon Sud, 195, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Département de radiothérapie, CHU de Casablanca, Casablanca, Maroc
| | - O Chapet
- Département de radiothérapie, CHU Lyon Sud, 195, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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