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Klain M, Gaudieri V, Petretta M, Zampella E, Storto G, Nappi C, Buonerba C, Crocetto F, Gallicchio R, Volpe F, Pace L, Schlumberger M, Cuocolo A. Combined bone scintigraphy and fluorocholine PET/computed tomography predicts response to radium-223 therapy in patients with prostate cancer. Future Sci OA 2021; 7:FSO719. [PMID: 34295537 PMCID: PMC8288237 DOI: 10.2144/fsoa-2021-0053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To assess the value of bone scintigraphy and 18F-fluorocholine PET/computed tomography (CT) in predicting outcome in patients with prostate cancer and bone metastases treated with 223radium. Materials & methods Retrospective analysis of 48 patients that underwent 223radium therapy. End points were pain relief and overall survival. Results After therapy, pain relief was observed in 27 patients. Patients without pain relief had more bone lesions at PET/CT than at bone scintigraphy (pretherapy imaging mismatch). In 39 patients who completed treatment protocol, post-therapy alkaline phosphatase and pretherapy imaging mismatch were independent predictors of poor overall survival. Conclusion Patients with more lesions at 18F-fluorocholine PET/CT than at bone scintigraphy had a poor prognosis. The combined imaging approach could be useful to predict outcome after 223radium therapy.
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Affiliation(s)
- Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Storto
- Nuclear Medicine Unit, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carlo Buonerba
- Department of Oncology & Hematology, Regional Reference Center for Rare Tumors, AOU Federico II of Naples, Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Rosj Gallicchio
- Nuclear Medicine Unit, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Fabio Volpe
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Leonardo Pace
- Department of Medicine, Surgery & Dentistry, University of Salerno, Salerno, Italy
| | - Martin Schlumberger
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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2
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Yang DM, Li F, Bauman G, Chin J, Pautler S, Moussa M, Rachinsky I, Valliant J, Lee TY. Kinetic analysis of dominant intraprostatic lesion of prostate cancer using quantitative dynamic [ 18F]DCFPyL-PET: comparison to [ 18F]fluorocholine-PET. EJNMMI Res 2021; 11:2. [PMID: 33394284 PMCID: PMC7782622 DOI: 10.1186/s13550-020-00735-w] [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: 06/16/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Identification of the dominant intraprostatic lesion(s) (DILs) can facilitate diagnosis and treatment by targeting biologically significant intra-prostatic foci. A PSMA ligand, [18F]DCFPyL (2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid), is better than choline-based [18F]FCH (fluorocholine) in detecting and localizing DIL because of higher tumour contrast, particularly when imaging is delayed to 1 h post-injection. The goal of this study was to investigate whether the different imaging performance of [18F]FCH and [18F]DCFPyL can be explained by their kinetic behaviour in prostate cancer (PCa) and to evaluate whether DIL can be accurately detected and localized using a short duration dynamic positron emission tomography (PET). Methods 19 and 23 PCa patients were evaluated with dynamic [18F]DCFPyL and [18F]FCH PET, respectively. The dynamic imaging protocol with each tracer had a total imaging time of 22 min and consisted of multiple frames with acquisition times from 10 to 180 s. Tumour and benign tissue regions identified by sextant biopsy were compared using standardized uptake value (SUV) and tracer kinetic parameters from kinetic analysis of time-activity curves. Results For [18F]DCFPyL, logistic regression identified Ki and k4 as the optimal model to discriminate tumour from benign tissue (84.2% sensitivity and 94.7% specificity), while only SUV was predictive for [18F]FCH (82.6% sensitivity and 87.0% specificity). The higher k3 (binding) of [18F]FCH than [18F]DCFPyL explains why [18F]FCH SUV can differentiate tumour from benign tissue within minutes of injection. Superior [18F]DCFPyL tumour contrast was due to the higher k4/k3 (more rapid washout) in benign tissue compared to tumour tissue. Conclusions DIL was detected with good sensitivity and specificity using 22-min dynamic [18F]DCFPyL PET and avoids the need for delayed post-injection imaging timepoints. The dissimilar in vivo kinetic behaviour of [18F]DCFPyL and [18F]FCH could explain their different SUV images. Clinical Trial Registration NCT04009174 (ClinicalTrials.gov).
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Affiliation(s)
- Dae-Myoung Yang
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Robarts Research Institute, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5B7, Canada.,Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada
| | - Fiona Li
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Robarts Research Institute, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5B7, Canada.,Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada
| | - Glenn Bauman
- Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Joseph Chin
- Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Stephen Pautler
- Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Madeleine Moussa
- Pathology and Laboratory Medicine, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Irina Rachinsky
- Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada
| | - John Valliant
- Centre for Probe Development and Commercialization, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Ting-Yim Lee
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada. .,Robarts Research Institute, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5B7, Canada. .,Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada. .,Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
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3
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Detection Rate of 18F-Fluorethylcholine-PET/CT in relation to PSA Value in PCA Patients Referred with Biochemical Relapse. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:4320178. [PMID: 32848525 PMCID: PMC7439168 DOI: 10.1155/2020/4320178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/19/2020] [Accepted: 04/27/2020] [Indexed: 11/18/2022]
Abstract
Attempts to predict the likelihood of positive morphological imaging related with PSA value in patients referred with biochemical recurrence were the focus of many studies. Using nuclear medicine modalities, numerous studies likewise had been performed for the same purpose, however mostly using C-11-labeled choline. For this purpose, we selected 193 prostate cancer patients from our database between 2006 and 2010. They had been referred to our department to undergo 18F-fluorethylcholine (FECH)-PET/CT due to biochemical recurrence after potentially curative procedures. As a result, in 84 out of 193 patients, 18F-FECH-PET demonstrated positive findings with an overall detection rate of 44%. Statistically, there was a significant difference in PSA values in positive findings vs. negative findings (p < 0.001), and there was a linear correlation between the detection rate and PSA value (r = 0.91). Moreover, there was a relation between initial therapy and recurrence type. So, the local relapse was the most frequent recurrence (>70%) after radiation therapy alone. By contrast, patients after radical prostatectomy followed by salvage radiotherapy showed a low likelihood of local recurrence. In conclusion, PSA value was confirmed to have a determinant role in 18F-FECH-PET outcome. Moreover, there was a link between recurrence type and initial therapy, which—if prospectively confirmed—may play a guiding role in selecting the appropriate diagnostic methods.
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Abstract
Prostate cancer is the commonest malignancy to affect men in the United Kingdom. Extraprostatic disease detection at staging and in the setting of biochemical recurrence is essential in determining treatment strategy. Conventional imaging including computed tomography and bone scintigraphy are limited in their ability to detect sites of loco-regional nodal and metastatic bone disease, particularly at clinically relevant low prostate-specific antigen levels. The use of positron emission tomography-computed tomography has helped overcome these deficiencies and is leading a paradigm shift in the management of prostate cancer using a wide range of radiopharmaceuticals. Their mechanisms of action, utility in both staging and biochemical recurrence, and comparative strengths and weaknesses will be covered in this article.
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Affiliation(s)
- Manil Subesinghe
- King's College London & Guy's & St. Thomas' PET Centre, St. Thomas' Hospital, London, UK; Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Meghana Kulkarni
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gary J Cook
- King's College London & Guy's & St. Thomas' PET Centre, St. Thomas' Hospital, London, UK; Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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5
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Mesguich C, Hulin C, Lascaux A, Bordenave L, Marit G, Hindié E. Choline PET/CT in Multiple Myeloma. Cancers (Basel) 2020; 12:E1394. [PMID: 32481661 PMCID: PMC7352763 DOI: 10.3390/cancers12061394] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023] Open
Abstract
The field of multiple myeloma (MM) imaging has evolved. The International Myeloma Working Group recently recommended performing 18F-fluorodeoxyglucose glucose (18FDG) positron emission tomography/computed tomography (PET/CT) with the aim of staging MM patients at baseline and evaluating response to therapy. Novel oncological radiotracers such as 11C-Choline and 18F-Fluorocholine, have been studied in comparison with 18FDG, mostly in MM patients presenting with refractory disease or suspected relapse. Choline-based tracers may overcome some limitations of 18FDG, which include a lack of sensitivity in depicting skull lesions and the fact that 10% of MM patients are FDG-negative. The majority of MM lesions display a higher uptake of Choline than FDG. Also, in many situations, Choline may offer better lesion visualization, with a higher tumor to background ratio; however, various patterns of Choline and FDG uptake have been observed in MM and some limitations, notably as regards liver lesions, should be recognized. Overall, Choline may provide additional detection of up to 75% more lesions. This article aims to provide a comprehensive review of the potential role of Choline in multiple myeloma, as compared to FDG, encompassing Choline physiopathology as well as data from clinical studies.
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Affiliation(s)
- Charles Mesguich
- CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France; (L.B.); (E.H.)
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
| | - Cyrille Hulin
- CHU Bordeaux, Haematology, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Axelle Lascaux
- CHU Bordeaux, Haematology, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Laurence Bordenave
- CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Gerald Marit
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
| | - Elif Hindié
- CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France; (L.B.); (E.H.)
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6
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Magalhães FL, Machado AMC, Paulino E, Sahoo SK, de Paula AM, Garcia AM, Barman I, Soares JS, Mamede M. Raman spectroscopy with a 1064-nm wavelength laser as a potential molecular tool for prostate cancer diagnosis: a pilot study. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-6. [PMID: 30392196 DOI: 10.1117/1.jbo.23.12.121613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/17/2018] [Indexed: 06/08/2023]
Abstract
Raman spectroscopy is widely used to investigate the structure and property of the molecules from their vibrational transitions and may allow for the diagnosis of cancer in a fast, objective, and nondestructive manner. This experimental study aims to propose the use of the 1064-nm wavelength laser in a Raman spectroscopy and to evaluate its discrimination capability in prostate cancer diagnosis. Seventy-four spectra from patients who underwent radical prostatectomy were evaluated. The acquired signals were filtered, normalized, and corrected for possible oscillations in the laser intensity and fluorescence effects. Wilcoxon tests revealed significant differences between the benign and malign samples associated with the deformation vibration characteristic of nucleic acids, proteins, and lipids. A classifier based on support vector machines was able to predict the Gleason scores of the samples with 95% of accuracy, opening a perspective for the use of the 1064-nm excitatory wavelength in prostatic cancer diagnosis.
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Affiliation(s)
- Felipe L Magalhães
- Federal University of Minas Gerais, School of Medicine, Belo Horizonte, Brazil
| | - Alexei M C Machado
- Federal University of Minas Gerais, School of Medicine, Belo Horizonte, Brazil
- Pontifical Catholic University of Minas Gerais, Graduate Program on Electrical Engineering, Belo Hor, Brazil
| | - Eduardo Paulino
- Federal University of Minas Gerais, School of Medicine, Belo Horizonte, Brazil
| | - Sangram K Sahoo
- Federal University of Minas Gerais, Department of Physics, Belo Horizonte, Brazil
| | - Ana M de Paula
- Federal University of Minas Gerais, Department of Physics, Belo Horizonte, Brazil
| | - Aloísio M Garcia
- Federal University of Minas Gerais, Department of Physics, Belo Horizonte, Brazil
| | - Ishan Barman
- Johns Hopkins School of Medicine, Department of Oncology, Baltimore, Maryland, United States
- Johns Hopkins University, Department of Mechanical Engineering, Baltimore, Maryland, United States
| | - Jaqueline S Soares
- Federal University of Ouro Preto, Department of Physics, Campus Universitário Morro do Cruzeiro, Our, Brazil
| | - Marcelo Mamede
- Federal University of Minas Gerais, School of Medicine, Belo Horizonte, Brazil
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7
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Incidental Detection of a Melanoma by 18F-Fluorocholine PET/CT Performed for Evaluation of Primary Hyperparathyroidism. Clin Nucl Med 2018; 43:265-266. [DOI: 10.1097/rlu.0000000000001972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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PET and PET/CT with radiolabeled choline in prostate cancer: a critical reappraisal of 20 years of clinical studies. Eur J Nucl Med Mol Imaging 2017; 44:1751-1776. [PMID: 28409220 DOI: 10.1007/s00259-017-3700-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/31/2017] [Indexed: 12/12/2022]
Abstract
We here aim to provide a comprehensive and critical review of the literature concerning the clinical applications of positron emission tomography/computed tomography (PET/CT) with radiolabeled choline in patients with prostate cancer (PCa). We will initially briefly summarize the historical context that brought to the synthesis of [11C]choline, which occurred exactly 20 years ago. We have arbitrarily grouped the clinical studies in three different periods, according to the year in which they were published and according to their relation with their applications in urology, radiotherapy and oncology. Studies at initial staging and, more extensively, studies in patients with biochemical failure, as well as factors predicting positive PET/CT will be reviewed. The capability of PET/CT with radiolabeled choline to provide prognostic information on PCa-specific survival will also be examined. The last sections will be devoted to the use of radiolabeled choline for monitoring the response to androgen deprivation therapy, radiotherapy, and chemotherapy. The accuracy and the limits of the technique will be discussed according to the information available from standard validation processes, including biopsy or histology. The clinical impact of the technique will be discussed on the basis of changes induced in the management of patients and in the evaluation of the response to therapy. Current indications to PET/CT, as officially endorsed by guidelines, or as routinely performed in the clinical practice will be illustrated. Emphasis will be made on methodological factors that might have influenced the results of the studies or their interpretation. Finally, we will briefly highlight the potential role of positron emission tomography/magnetic resonance and of new radiotracers for PCa imaging.
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10
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Abstract
Conventional anatomical imaging with CT and MRI has limitations in the evaluation of prostate cancer. PET is a powerful imaging technique, which can be directed toward molecular targets as diverse as glucose metabolism, density of prostate-specific membrane antigen receptors, and skeletal osteoblastic activity. Although 2-deoxy-2-18F-FDG-PET is the mainstay of molecular imaging, FDG has limitations in typically indolent prostate cancer. Yet, there are many useful and emerging PET tracers beyond FDG, which provide added value. These include radiotracers interrogating prostate cancer via molecular mechanisms related to the biology of choline, acetate, amino acids, bombesin, and dihydrotestosterone, among others. Choline is used for cell membrane synthesis and its metabolism is upregulated in prostate cancer. 11C-choline and 18F-choline are in wide clinical use outside the United States, and they have proven most beneficial for detection of recurrent prostate cancer. 11C-acetate is an indirect biomarker of fatty acid synthesis, which is also upregulated in prostate cancer. Imaging of prostate cancer with 11C-acetate is overall similar to the choline radiotracers yet is not as widely used. Upregulation of amino acid transport in prostate cancer provides the biologic basis for amino acid-based radiotracers. Most recent progress has been made with the nonnatural alicyclic amino acid analogue radiotracer anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid (FACBC or fluciclovine) also proven most useful for the detection of recurrent prostate cancer. Other emerging PET radiotracers for prostate cancer include the bombesin group directed to the gastrin-releasing peptide receptor, 16β-18F-fluoro-5α-dihydrotestosterone (FDHT) that binds to the androgen receptor, and those targeting the vasoactive intestinal polypeptide receptor 1 (VPAC-1) and urokinase plasminogen activator receptor (uPAR), which are also overexpressed in prostate cancer.
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Affiliation(s)
- David M Schuster
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.
| | - Cristina Nanni
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
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11
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Lee MS, Cho JY, Kim SY, Cheon GJ, Moon MH, Oh S, Lee J, Lee S, Woo S, Kim SH. Diagnostic value of integrated PET/MRI for detection and localization of prostate cancer: Comparative study of multiparametric MRI and PET/CT. J Magn Reson Imaging 2016; 45:597-609. [PMID: 27586519 DOI: 10.1002/jmri.25384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/23/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the diagnostic value of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) compared with conventional multiparametric MRI and PET/computed tomography (CT) for the detailed and accurate segmental detection/localization of prostate cancer. MATERIALS AND METHODS Thirty-one patients who underwent integrated PET/MRI using 18 F-choline and 18 F-FDG with an integrated PET/MRI scanner followed by radical prostatectomy were included. The prostate was divided into six segments (sextants) according to anatomical landmarks. Three radiologists noted the presence and location of cancer in each sextant on four different image interpretation modalities in consensus (1, multiparametric MRI; 2, integrated 18 F-FDG PET/MRI; 3, integrated 18 F-choline PET/MRI; and 4, combined interpretation of 1 and 18 F-FDG PET/CT). Sensitivity, specificity, accuracy, positive and negative predictive values, likelihood ratios, and diagnostic performance based on the DOR (diagnostic odds ratio) and NNM (number needed to misdiagnose) were evaluated for each interpretation modality, using the pathologic result as the reference standard. Detection rates of seminal vesicle invasion and extracapsular invasion were also evaluated. RESULTS Integrated 18 F-choline PET/MRI showed significantly higher sensitivity than did multiparametric MRI alone in high Gleason score patients (77.0% and 66.2%, P = 0.011), low Gleason score patients (66.7% and 47.4%, P = 0.007), and total patients (72.5% and 58.0%, P = 0.008) groups. Integrated 18 F-choline PET/MRI and 18 F-FDG PET/MRI showed similar sensitivity and specificity to combined interpretation of multiparametric MRI and 18 F-FDG PET/CT (for sensitivity, 58.0%, 63.4%, 72.5%, and 68.7%, respectively, and for specificity, 87.3%, 80.0%, 81.8%, 72.7%, respectively, in total patient group). However, integrated 18 F-choline PET/MRI showed the best diagnostic performance (as DOR, 11.875 in total patients, 27.941 in high Gleason score patients, 5.714 in low Gleason score groups) among the imaging modalities, regardless of Gleason score. Integrated 18 F-choline PET/MRI showed higher sensitivity and diagnostic performance than did integrated 18 F-FDG PET/MRI (as DOR, 6.917 in total patients, 15.143 in high Gleason score patients, 3.175 in low Gleason score groups) in all three patient groups. CONCLUSION Integrated PET/MRI carried out using a dedicated integrated PET/MRI scanner provides better sensitivity, accuracy, and diagnostic value for detection/localization of prostate cancer compared to multiparametric MRI. Generally, integrated 18 F-choline PET/MRI shows better sensitivity, accuracy, and diagnostic performance than does integrated 18 F-FDG PET/MRI as well as combined interpretation of multiparametric MRI with 18 F-FDG PET/CT. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:597-609.
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Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sungmin Woo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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12
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Abstract
Although PET using fludeoxyglucose F 18 (FDG) is a promising modality for metabolic imaging of different tumors, the results in prostate cancer have been somewhat inconsistent. Low FDG avidity of most prostate cancer cells and urinary activity are suggested as the main limitations of FDG PET for the evaluation of prostate cancer. Prostate cancer exhibits increased choline metabolism, which is the rationale for using radiolabeled choline for PET. This article describes the basic concepts of radiolabeled choline regarding pharmacokinetics, radiation dosimetry, synthesis, and biodistribution, in addition to advances concerning clinical PET using 11C- and 18F-choline in primary staging and restaging of prostate cancer patients.
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Affiliation(s)
- Mohsen Beheshti
- Department of Nuclear Medicine & Endocrinology, PET-CT Center Linz, St. Vincent's Hospital, Seilerstaette 4, A-4020 Linz, Austria
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13
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Piert M, Montgomery J, Kunju LP, Siddiqui J, Rogers V, Rajendiran T, Johnson TD, Shao X, Davenport MS. 18F-Choline PET/MRI: The Additional Value of PET for MRI-Guided Transrectal Prostate Biopsies. J Nucl Med 2016; 57:1065-70. [PMID: 26985061 DOI: 10.2967/jnumed.115.170878] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED We assessed the value of fusion (18)F-fluoromethylcholine ((18)F-choline) PET/MRI for image-guided (targeted) prostate biopsies to detect significant prostate cancer (Gleason ≥ 3 + 4) compared with standard (systematic 12-core) biopsies. METHODS Within an ongoing prospective clinical trial, hybrid (18)F-choline PET/CT and multiparametric 3T MRI (mpMRI) of the pelvis were performed in 36 subjects with a rising prostate-specific antigen for known (n = 15) or suspected (n = 21) prostate cancer before a prostate biopsy procedure. PET and T2-weighted MR volumes of the prostate were spatially registered using commercially available software. Biopsy targets were selected on the basis of visual appearance on MRI and graded as low, intermediate, or high risk for significant disease. Volumes of interest were defined for MR-identified lesions. (18)F-choline uptake measures were obtained from the MR target and a mirrored background volume of interest. The biopsy procedure was performed after registration of real-time transrectal ultrasound with T2-weighted MR and included image-guided cores plus standard cores. Histologic results were determined from standard and targeted biopsy cores as well as prostatectomy specimens (n = 10). RESULTS Fifteen subjects were ultimately identified with Gleason ≥ 3 + 4 prostate cancer, of which targeted biopsy identified significantly more (n = 12) than standard biopsies (n = 5; P = 0.002). A total of 52 lesions were identified by mpMRI (19 low, 18 intermediate, 15 high risk), and mpMRI-assigned risk was a strong predictor of final pathology (area under the curve = 0.81; P < 0.001). When the mean (18)F-choline target-to-background ratio was used, the addition of (18)F-choline to mpMRI significantly improved the prediction of Gleason ≥ 3 + 4 cancers over mpMRI alone (area under the curve = 0.92; P < 0.001). CONCLUSION Fusion PET/MRI transrectal ultrasound image registration for targeted prostate biopsies is clinically feasible and accurate. The addition of (18)F-choline PET to mpMRI improves the identification of significant prostate cancer.
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Affiliation(s)
- Morand Piert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Javed Siddiqui
- Department of Pathology, University of Michigan, Ann Arbor, Michigan; and
| | - Virginia Rogers
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | | | - Timothy D Johnson
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Xia Shao
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Maines F, Caffo O, Donner D, Sperduti I, Bria E, Veccia A, Chierichetti F, Tortora G, Galligioni E. Serial 18F-choline-PET imaging in patients receiving enzalutamide for metastatic castration-resistant prostate cancer: response assessment and imaging biomarkers. Future Oncol 2016; 12:333-42. [PMID: 26768648 DOI: 10.2217/fon.15.277] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM High rate of non-target lesions in metastatic castration-resistant prostate cancer usually limits applicability of Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and this has led to a growing interest in using PET/computed tomography (CT). We prospectively investigated the role of (18)F-choline (FCH)-PET/CT in patients receiving enzalutamide after docetaxel. PATIENTS & METHODS 30 patients were monitored by means of FCH-PET/CT before and during the treatment. A Cox proportional hazards regression model was used to assess the associations between metabolic parameters and clinical outcomes. RESULTS Univariate analysis showed no significant correlation between biochemical and FCH-PET responses. Multivariate analysis showed that only baseline maximum standardized uptake value (SUVmax) significantly correlated with biochemical progression-free survival, radiological progression-free survival and overall survival. CONCLUSION Our findings suggest that FCH-PET/CT may play a role in defining prognosis of patients receiving enzalutamide because baseline SUVmax proved to be an independent prognostic factor.
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Affiliation(s)
- Francesca Maines
- Medical Oncology, S. Chiara Hospital, Largo Medaglie d'oro 1, 38100 Trento, Italy
| | - Orazio Caffo
- Medical Oncology, S. Chiara Hospital, Largo Medaglie d'oro 1, 38100 Trento, Italy
| | - Davide Donner
- Nuclear Medicine, S. Chiara Hospital, Largo Medaglie d'oro 1, 38100 Trento, Italy
| | | | - Emilio Bria
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Antonello Veccia
- Medical Oncology, S. Chiara Hospital, Largo Medaglie d'oro 1, 38100 Trento, Italy
| | - Franca Chierichetti
- Nuclear Medicine, S. Chiara Hospital, Largo Medaglie d'oro 1, 38100 Trento, Italy
| | - Giampaolo Tortora
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Enzo Galligioni
- Medical Oncology, S. Chiara Hospital, Largo Medaglie d'oro 1, 38100 Trento, Italy
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Is choline PET useful for identifying intraprostatic tumour lesions? A literature review. Nucl Med Commun 2015; 36:871-80. [DOI: 10.1097/mnm.0000000000000338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Garcia JR, Cuberas G, Riera E, Soler M, Moragas M, Lomeña F. Dual-phase 11C-choline PET/computed tomography in the early evaluation of prostate cancer recurrence. Nucl Med Commun 2015; 36:8-15. [PMID: 25299466 DOI: 10.1097/mnm.0000000000000207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE The aim of this study was to assess dual-phase 11C-choline PET/computed tomography (CT) for differentiating benign from malignant lesions in patients with biochemical recurrence of prostate cancer. MATERIALS AND METHODS We prospectively studied 56 patients with prostate cancer treated by surgery (n=22) or radiotherapy (n=34) who had hypermetabolic foci on 11C-choline PET/CT determined for biochemical recurrence (prostate-specific antigen 1.23-9.9 ng/ml). We used the dual-phase technique, calculating the standardized uptake value (SUV) for early (SUVearly) and late (SUVdelay) acquisitions and the difference between the two (SUVvariation) to determine whether tracer uptake remained stable or increased (accumulative pattern) or decreased (washout pattern). We used t-tests to compare mean and receiver operating characteristic curve analysis (SUVearly/SUVdelay/SUVvariation vs. benign/malignant). RESULTS We identified 106 hypermetabolic foci (34 local, 10 inguinal, 34 infradiaphragmatic, 14 supradiaphragmatic, and 14 in bone). We identified 34 local foci (eight after prostatectomy and 26 after radiotherapy). The eight postsurgical foci had an accumulative pattern and recurrence was confirmed (three histology, five follow-up). Of the 26 postradiotherapy foci, three had a washout pattern and follow-up ruled out recurrence; 23 had an accumulative pattern and recurrence was confirmed (14 histology, nine follow-up). The 10 inguinal foci had a washout pattern and were reactive (three histology, seven follow-up). The 34 infradiaphragmatic foci had an accumulative pattern and were malignant (34 follow-up). Of the 14 supradiaphragmatic foci, the three with a washout pattern were benign (three histology) and the 11 with an accumulative pattern were malignant (11 histology). Of the 14 foci in bone, two had a washout pattern and corresponded with signs of spondyloarthropathy. On the receiver operating characteristic curve analysis, SUVvariation best discriminated benign from malignant lesions [area under the curve (AUC)=0.993], followed by SUVdelay (AUC=0.933) and finally SUVearly (AUC=0.665). CONCLUSION Dual-phase PET/CT with 11C-choline is technically feasible despite this tracer's short physical half-life and is useful for discriminating benign from malignant lesions. SUVvariation accurately discriminated between benign and malignant lesions.
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Anthracosis Mimicking Mediastinal Lymph Node Metastases With 18F-FCholine in High-Risk Prostate Cancer. Clin Nucl Med 2015; 40:e253-4. [DOI: 10.1097/rlu.0000000000000707] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Usefulness of MRI-assisted metabolic volumetric parameters provided by simultaneous 18F-fluorocholine PET/MRI for primary prostate cancer characterization. Eur J Nucl Med Mol Imaging 2015; 42:1247-56. [DOI: 10.1007/s00259-015-3026-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/19/2015] [Indexed: 12/24/2022]
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Takesh M. Kinetic Modeling Application to (18)F-fluoroethylcholine Positron Emission Tomography in Patients with Primary and Recurrent Prostate Cancer Using Two-tissue Compartmental Model. World J Nucl Med 2014; 12:101-10. [PMID: 25214813 PMCID: PMC4145150 DOI: 10.4103/1450-1147.136734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although 18F-fludeoxyglucose-positron emission tomography (PET) is the most applied diagnostic method in tumor staging, its role in prostate cancer (PCA) is limited because glucose metabolism tends to be low unless PCA has high Gleason score. Alternatively, choline PET was introduced as a valuable imaging method. Kinetic analysis of PET acquisition has increasingly gained momentum as an investigative tool because it provides a non-invasive approach to obtain kinetic and metabolic data from tissues of interest including transport and metabolism of the administered material. In this regard, we sought to apply it in 18F-fluoroethylcholine (FECH)-PET/computed tomography (CT) in patients with PCA. 64 patients, the mean age 69 (range: 47-87 years) with primary/recurrent PCA were encompassed. They underwent 18F-FECH-PET started with a dynamic acquisition using a 20-frame each 30 s over the prostate region and followed at 1 h post-injection by a static whole body imaging. The kinetic evaluation of the data was performed using the software package PMOD (PMOD Technologies Ltd., Zürich, Switzerland). Significant increase in mean values for K1, K3, FD, standardized uptake value (SUV) and global influx in tumor tissue versus normal tissue (P < 0.05). Moderate but significant correlation (r: 0.28, P = 0.023) between SUV and K1. By contrast, no correlation between SUV and K3 (r: −0.08, P = 0.79). In patients with recurrent tumors, there is no significant difference in all kinetic parameters and SUV (P > 0.1) between the different types of recurrences. The kinetic analysis of dynamic FECH-PET provides a novel method in primary PCA diagnosis and could be of potential value in the delineation of tumor focus.
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Affiliation(s)
- Mustafa Takesh
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg ; Department of Nuclear Medicine and Radiology, Knappschaft Hospital, 66280 Sulzbach, Germany
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20
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de Perrot T, Rager O, Scheffler M, Lord M, Pusztaszeri M, Iselin C, Ratib O, Vallee JP. Potential of hybrid ¹⁸F-fluorocholine PET/MRI for prostate cancer imaging. Eur J Nucl Med Mol Imaging 2014; 41:1744-55. [PMID: 24841413 DOI: 10.1007/s00259-014-2786-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/15/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To report the first results of hybrid (18)F-fluorocholine PET/MRI imaging for the detection of prostate cancer. METHODS This analysis included 26 consecutive patients scheduled for prostate PET/MRI before radical prostatectomy. The examinations were performed on a hybrid whole-body PET/MRI scanner. The MR acquisitions which included T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences were followed during the same session by whole-body PET scans. Parametric maps were constructed to measure normalized T2-weighted intensity (nT2), apparent diffusion coefficient (ADC), volume transfer constant (K (trans)), extravascular extracellular volume fraction (v e) and standardized uptake values (SUV). With pathology as the gold standard, ROC curves were calculated using logistic regression for each parameter and for the best combination with and without PET to obtain a MR model versus a PETMR model. RESULTS Of the 26 patients initially selected, 3 were excluded due to absence of an endorectal coil (2 patients) or prosthesis artefacts (1 patient). In the whole prostate, the area under the curve (AUC) for SUVmax, ADC, nT2, K (trans) and v e were 0.762, 0.756, 0.685, 0.611 and 0.529 with a best threshold at 3.044 for SUVmax and 1.075 × 10(-3) mm(2)/s for ADC. The anatomical distinction between the transition zone and the peripheral zone showed the potential of the adjunctive use of PET. In the peripheral zone, the AUC of 0.893 for the PETMR model was significantly greater (p = 0.0402) than the AUC of 0.84 for the MR model only. In the whole prostate, no relevant correlation was observed between ADC and SUVmax. The SUVmax was not affected by the Gleason score. CONCLUSION The performance of a hybrid whole-body (18)F-fluorocholine PET/MRI scan in the same session combined with a prostatic MR examination did not interfere with the diagnostic accuracy of the MR sequences. The registration of the PET data and the T2 anatomical MR sequence data allowed precise localization of hypermetabolic foci in the prostate. While in the transition zone the adenomatous hyperplasia interfered with cancer detection by PET, the quantitative analysis tool performed well for cancer detection in the peripheral zone.
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Affiliation(s)
- Thomas de Perrot
- Division of Radiology, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland,
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21
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Wiehr S, Bühler P, Gierschner D, Wolf P, Rolle AM, Kesenheimer C, Pichler BJ, Elsässer-Beile U. Pharmacokinetics and PET imaging properties of two recombinant anti-PSMA antibody fragments in comparison to their parental antibody. Prostate 2014; 74:743-55. [PMID: 24610028 DOI: 10.1002/pros.22794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/31/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Radioimmunoimaging with disease-specific tracers can be advantageous compared to that with nonspecific tracers for the imaging of glucose metabolism and cell proliferation. Monoclonal antibodies (mAbs) or their fragments are excellent tools for immuno-positron emission tomography (PET). In this study, PSMA-specific mAb 3/F11 and its recombinant fragments were compared for the imaging of prostate cancer in xenografts. METHODS Recombinant anti-PSMA antibody fragments D7-Fc and D7-CH3 were constructed by genetically fusing the binding domains of mAb 3/F11 (D7) to the human IgG3 CH3 or CH2-CH3 (Fc) domain. The fragments and the mAb 3/F11 were DOTA conjugated, tested in vitro, and radiolabeled with (64) Cu. PSMA-positive C4-2 and PSMA-negative DU 145 prostate cancer xenografts were used for PET-MR imaging and for ex vivo biodistribution. RESULTS The constructs showed strong and specific binding to PSMA-positive C4-2 cells in vitro which did not decrease after DOTA conjugation. Both tested fragments showed stable accumulation in PSMA-positive C4-2 tumors at all measured time points but reduced uptake compared to the full-length antibody. Other organs and PSMA-negative tumors showed a very low tracer uptake only 3 hr after injection, with the exception of the kidneys, which demonstrated high radioactivity uptake due to rapid renal clearance of the mAb fragments. CONCLUSION Stable tumor uptake and fast serum clearance of the tested radiolabeled fragments was observed in this preclinical study compared to the full length mAb. Since the fragments show rapid and specific tumor uptake, the tested fragments might serve as tools for theranostic imaging with suitable isotopes for radioimmunotherapy.
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Affiliation(s)
- Stefan Wiehr
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University, Tübingen, Germany
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Hartenbach M, Hartenbach S, Bechtloff W, Danz B, Kraft K, Klemenz B, Sparwasser C, Hacker M. Combined PET/MRI Improves Diagnostic Accuracy in Patients with Prostate Cancer: A Prospective Diagnostic Trial. Clin Cancer Res 2014; 20:3244-53. [DOI: 10.1158/1078-0432.ccr-13-2653] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Detection of second tumors in 11C-choline PET/CT studies performed due to biochemical recurrence of prostate cancer. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2013.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Alongi F, De Bari B, Campostrini F, Arcangeli S, Matei DV, Lopci E, Petralia G, Bellomi M, Chiti A, Magrini SM, Scorsetti M, Orecchia R, Jereczek-Fossa BA. Salvage therapy of intraprostatic failure after radical external-beam radiotherapy for prostate cancer: A review. Crit Rev Oncol Hematol 2013; 88:550-63. [DOI: 10.1016/j.critrevonc.2013.07.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 05/20/2013] [Accepted: 07/17/2013] [Indexed: 01/29/2023] Open
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Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2013; 41:11-20. [PMID: 24072344 PMCID: PMC3843747 DOI: 10.1007/s00259-013-2525-5] [Citation(s) in RCA: 694] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/17/2013] [Indexed: 01/24/2023]
Abstract
PURPOSE Positron emission tomography (PET) with choline tracers has found widespread use for the diagnosis of prostate cancer (PC). However, choline metabolism is not increased in a considerable number of cases, whereas prostate-specific membrane antigen (PSMA) is overexpressed in most PCs. Therefore, a (68)Ga-labelled PSMA ligand could be superior to choline tracers by obtaining a high contrast. The aim of this study was to compare such a novel tracer with standard choline-based PET/CT. METHODS Thirty-seven patients with biochemical relapse of PC [mean prostate-specific antigen (PSA) 11.1 ± 24.1 ng/ml, range 0.01-116] were retrospectively analysed after (18)F-fluoromethylcholine and (68)Ga-PSMA PET/CT within a time window of 30 days. Radiotracer uptake that was visually considered as PC was semi-quantitatively analysed by measuring the maximum standardized uptake values (SUVmax) of the scans acquired 1 h after injection of (68)Ga-PSMA complex solution (median 132 MBq, range 59-263 MBq) and (18)F-fluoromethylcholine (median 237 MBq, range 114-374 MBq), respectively. In addition, tumour to background ratios were calculated. RESULTS A total of 78 lesions characteristic for PC were detected in 32 patients using (68)Ga-PSMA PET/CT and 56 lesions were detected in 26 patients using choline PET/CT. The higher detection rate in (68)Ga-PSMA PET/CT was statistically significant (p=0.04). In five patients no lesion was found with both methods. All lesions detected by (18)F-fluoromethylcholine PET/CT were also seen by (68)Ga-PSMA PET/CT. In (68)Ga-PSMA PET/CT SUVmax was clearly (>10 %) higher in 62 of 78 lesions (79.1 %) and the tumour to background ratio was clearly (>10 %) higher in 74 of 78 lesions (94.9 %) when compared to (18)F-fluoromethylcholine PET/CT. CONCLUSION (68)Ga-PSMA PET/CT can detect lesions characteristic for PC with improved contrast when compared to standard (18)F-fluoromethylcholine PET/CT, especially at low PSA levels.
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Turkbey B, Mena E, Aras O, Garvey B, Grant K, Choyke PL. Functional and molecular imaging: applications for diagnosis and staging of localised prostate cancer. Clin Oncol (R Coll Radiol) 2013; 25:451-60. [PMID: 23722008 DOI: 10.1016/j.clon.2013.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 05/02/2013] [Indexed: 01/13/2023]
Abstract
Prostate cancer is currently the most common solid organ cancer type among men in the Western world. Currently, all decision-making algorithms and nomograms rely on demographics, clinicopathological data and symptoms. Such an approach can easily miss significant cancers while detecting many insignificant cancers. In this review, novel functional and molecular imaging techniques used in the diagnosis and staging of localised prostate cancer and their effect on treatment decisions are discussed.
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Affiliation(s)
- B Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1088, USA.
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García J. Actualización del uso de radiofármacos en tomografía por emisión de positrones en el cáncer de próstata. Rev Esp Med Nucl Imagen Mol 2013; 32:177-86. [DOI: 10.1016/j.remn.2013.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/24/2022]
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García J. Update on the use of radiopharmaceuticals for positron emission tomography imaging of prostate cancer. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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García JR, Ponce A, Canales M, Ayuso J, Moragas M, Soler M. [Detection of second tumors in 11C-choline PET/CT studies performed due to biochemical recurrence of prostate cancer]. Rev Esp Med Nucl Imagen Mol 2013; 33:28-31. [PMID: 23499124 DOI: 10.1016/j.remn.2013.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 11/24/2022]
Abstract
Early localization of biochemical recurrence in patients after radical treatment of prostate cancer is a widely accepted clinical indication of (11)C-choline PET/CT. Its widespread clinical use has prompted the depiction of incidentalomas, unusual sites of metastatic lesions, as well as false positive and negative cases. Over the last 6 years, a total of 454 (11)C-choline PET/CT studies have been performed in our institution to locate biochemical recurrence of patients with prostate cancer. With these studies, a second neoplasm has been found in 7 patients (1.54%): 3 lung, 2 colorectal, 1 esophagus and 1 esophageal junction, respectively. Although the clinical usefulness of this technique for detecting cancer lesions other than prostate origin is known for those patients who undergo this technique in the accepted indication, the diagnosis of a second tumor has a significant impact on their therapeutic management.
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Affiliation(s)
- J R García
- Unitat PET, CETIR, Esplugues de Llobregat, Barcelona, España.
| | - A Ponce
- Unitat PET, CETIR, Esplugues de Llobregat, Barcelona, España
| | - M Canales
- Unitat PET, CETIR, Esplugues de Llobregat, Barcelona, España
| | - J Ayuso
- Unitat PET, CETIR, Esplugues de Llobregat, Barcelona, España
| | - M Moragas
- Unitat PET, CETIR, Esplugues de Llobregat, Barcelona, España
| | - M Soler
- Unitat PET, CETIR, Esplugues de Llobregat, Barcelona, España
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Takesh M. The Potential Benefit by Application of Kinetic Analysis of PET in the Clinical Oncology. ISRN ONCOLOGY 2012; 2012:349351. [PMID: 23326682 PMCID: PMC3541563 DOI: 10.5402/2012/349351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 11/25/2012] [Indexed: 12/22/2022]
Abstract
PET is an appropriate method to display the functional activities in target tissue using many types of traces. The visual assessment of PET images plus the semiquantitative parameter (SUV) are the main diagnostic standards considered in identifying the malignant lesion. However, these standards lack occasionally the proper specificity and/or sensitivity. That emphasizes the importance of considering supplemental diagnostic criteria such as the kinetic parameter. The latter gives the way to image the ongoing metabolic processes within the target tissue as well as to identify the alterations occurring at the microscale level before they become observable in the conventional PET-imaging.
The importance of kinetic analysis of PET imaging has increased with newly developed PET devices that offer images of good quality and high spatial resolution.
In this paper, we highlighted the potential contribution of kinetic analysis in improving the diagnostic accuracy in intracranial tumour, lung tumour, liver tumour, colorectal tumour, bone and soft tissue tumours, and prostate cancer. Moreover, we showed that the appropriate therapy monitoring can be best achieved after considering the kinetic parameters. These promising results indicate that the kinetic analysis of PET imaging may become an essential part in preclinical and clinical molecular imaging as well.
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Affiliation(s)
- Mustafa Takesh
- Nuclear Medicine Department, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Takesh M, Odat Allh K, Adams S, Zechmann C. Diagnostic Role of (18)F-FECH-PET/CT Compared with Bone Scan in Evaluating the Prostate Cancer Patients Referring with Biochemical Recurrence. ISRN ONCOLOGY 2012; 2012:815234. [PMID: 23251818 PMCID: PMC3515921 DOI: 10.5402/2012/815234] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 09/29/2012] [Indexed: 11/23/2022]
Abstract
18F-FECH-PET/CT has been proved to be an imaging agent for prostate carcinoma. However, its role in detecting the bone metastases is still blurred owing to the lack of related studies. The purpose of our study was to assess the efficacy of PET with 18F-ethylcholine in assessing the bone status and to compare the results with that of conventional bone scan findings. For this purpose, we selected 37 patients (mean age 69 ± 7), who had been referred for restaging purposes due to biochemical recurrences and underwent both 18F-FECH-PET/CT and bone scan in a short interval. Generally 18 patients out 37 patients referred with biochemical relapse were confirmed to have bone involvement. From 18 confirmed bone involvement cases, 18F-FECH-PET/CT identified correctly the bone involvement in 15 cases with overall sensitivity of 83.3%. On the other hand, bone scan identified 17 out of 18 confirmed cases with overall sensitivity of 94.4%. The lesion-related results show that the sensitivity of each investigation differs with the anatomical regions, and by comparing both results, 18F-FECH-PET/CT was mostly superior to bone scan; however, without a statistical significance (P > 0.1). In conclusion, no significant gain in sensitivity was achieved using bone scan compared with 18F-FECH-PET/CT.
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Affiliation(s)
- Mustafa Takesh
- Department of Nuclear Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Abstract
Functional radionuclide imaging modalities, now commonly combined with anatomical imaging modalities computed tomography (CT) or magnetic resonance imaging (single photon emission computed tomography [SPECT]/CT, positron emission tomography [PET]/CT, and PET/magnetic resonance imaging), are promising tools for the management of prostate cancer, particularly for therapeutic implications. Sensitive detection capability of prostate cancer using these imaging modalities is one issue; however, the treatment of prostate cancer using the information that can be obtained from functional radionuclide imaging techniques is another challenging area. There are not many SPECT or PET radiotracers that can cover the full spectrum of the management of prostate cancer from initial detection to staging, prognosis predictor, and all the way to treatment response assessment. However, when used appropriately, the information from functional radionuclide imaging improves, and sometimes significantly changes, the whole course of the cancer management. The limitations of using SPECT and PET radiotracers with regard to therapeutic implications are not so much different from their limitations solely for the task of detecting prostate cancer; however, the specific imaging target and how this target is reliably imaged by SPECT and PET can potentially make significant impact in the treatment of prostate cancer. Finally, although the localized prostate cancer is considered manageable, there is still significant need for improvement in noninvasive imaging of metastatic prostate cancer, in treatment guidance, and in response assessment from functional imaging, including radionuclide-based techniques. In this review article, we present the rationale of using functional radionuclide imaging and the therapeutic implications for each of radionuclide imaging agent that have been studied in human subjects.
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Affiliation(s)
- Carina Mari Aparici
- Department of Radiology and Biomedical Imaging, University of California, and Nuclear Medicine Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94107, USA
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Abstract
OBJECTIVE Recent advances in the fundamental understanding of the complex biology of prostate cancer have provided an increasing number of potential targets for imaging and treatment. The imaging evaluation of prostate cancer needs to be tailored to the various phases of this remarkably heterogeneous disease. CONCLUSION In this article, I review the current state of affairs on a range of PET radiotracers for potential use in the imaging evaluation of men with prostate cancer.
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Lütje S, Boerman OC, van Rij CM, Sedelaar M, Helfrich W, Oyen WJG, Mulders PFA. Prospects in radionuclide imaging of prostate cancer. Prostate 2012; 72:1262-72. [PMID: 22127918 DOI: 10.1002/pros.22462] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/31/2011] [Indexed: 11/07/2022]
Abstract
Prostate cancer is the most common malignancy in men in the Western world and represents a major health problem with substantial morbidity and mortality. Sensitivity and specificity of digital rectal examination (DRE) and evaluation of prostate specific antigen (PSA) are excellent methods for diagnosis of prostate cancer, but have limited value for staging. Imaging of prostate cancer has become increasingly important to improve staging and management of prostate cancer patients. Conventional imaging modalities, such as transrectal ultrasound and computed tomography, show limited accuracy for a reliable assessment of prostate cancer. Diagnostic value of magnetic resonance imaging has improved by dynamic contrast enhancement (DCI-MRI) and diffusion-weighted magnetic resonance imaging (DWI). Recently, substantial progress has been made in the development of functional and molecular imaging modalities, such as positron emission tomography using radiolabeled metabolic tracers, receptor-binding ligands, amino acids, peptides, or antibodies. Here, we review the value of these novel radionuclide imaging techniques in the assessment of prostate cancer.
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Affiliation(s)
- Susanne Lütje
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Imaging primary prostate cancer with 11C-Choline PET/CT: relation to tumour stage, Gleason score and biomarkers of biologic aggressiveness. Radiol Oncol 2012; 46:179-88. [PMID: 23077456 PMCID: PMC3472944 DOI: 10.2478/v10019-012-0034-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 05/03/2012] [Indexed: 02/08/2023] Open
Abstract
Background As a significant overlap of 11C-Choline standardized uptake value (SUV) between prostate cancer and benign prostate hyperplasia (BPH) tissue, controversy exists regarding the clinical value of 11C-Choline PET/CT scan in primary prostate cancer. In this study, the SUVmax of the prostate lesions and the pelvic muscles were measured and their ratios (SUVmax-P/M ratio) were calculated. Then we evaluated whether the tracer 11C-Choline uptake, quantified as SUVmax-P/M ratio, correlated with tumour stage, Gleason score, and expression levels of several biomarkers of aggressiveness. Methods Twenty-six patients with primary prostate cancer underwent 11C-Choline PET/CT. Tumour specimens from these patients were graded histopathologically, and immunnohistochemistry for Ki-67, CD31, androgen receptor (AR), Her-2/neu, Bcl-2, and PTEN were performed. Results Both SUVmax and SUVmax-P/M ratio showed no significant difference between patients with tumour stage II and III, but significantly elevated in patients with tumour stage IV. SUVmax-P/M ratio was also significantly higher in lesions with Gleason score of 4+3 or higher versus less than or equal to 3+4. SUVmax-P/M ratio was found significantly correlated with expression levels of Ki-67 and CD31. In addition, a higher SUVmax-P/M ratio was demonstrated in Her-2/neu positive subgroup than negative subgroup. At the same time, Gleason score and expression levels of these biomarkers showed no significant association with SUVmax. Conclusions Using the parameter SUVmax-P/M ratio, 11C-Choline PET/CT may be a valuable non-invasive imaging technology in the diagnosis of primary prostate cancer.
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Evans-Axelsson S, Ulmert D, Örbom A, Peterson P, Nilsson O, Wennerberg J, Strand J, Wingårdh K, Olsson T, Hagman Z, Tolmachev V, Bjartell A, Lilja H, Strand SE. Targeting free prostate-specific antigen for in vivo imaging of prostate cancer using a monoclonal antibody specific for unique epitopes accessible on free prostate-specific antigen alone. Cancer Biother Radiopharm 2012; 27:243-51. [PMID: 22489659 DOI: 10.1089/cbr.2011.1088] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study investigated the feasibility of targeting the free, unbound forms of prostate-specific antigen (fPSA) for in vivo imaging of prostate adenocarcinomas (PCa), as PSA is produced and secreted at abundance during every clinical stage and grade of PCa, including castration-resistant disease. We injected (125)I-labeled monoclonal antibody PSA30 (specific for an epitope uniquely accessible on fPSA alone) intravenously in male nude mice carrying subcutaneous xenografts of LNCaP tumors (n=36). Mice were sacrificed over a time course from 4 hours to 13 days after injecting (125)I-labeled PSA30. Tissue uptake of (125)I-PSA30 at 48 and 168 hours after intravenous injection was compared with two clinically used positron emission tomography radiopharmaceuticals, (18)F-fluoro-deoxy-glucose ((18)F-FDG) or (18)F-choline, in cryosections using Digital AutoRadiography (DAR) and also compared with immunohistochemical staining of PSA and histopathology. On DAR, the areas with high (125)I-PSA30 uptake corresponded mainly to morphologically intact and PSA-producing LNCaP cells, but did not associate with the areas of high uptake of either (18)F-FDG or (18)F-choline. Biodistribution of (125)I-PSA30 measured in dissected organs ex vivo during 4 to 312 hours after intravenous injection demonstrated maximum selective tumor uptake 24-48 hours after antibody injection. Our data showed selective uptake in vivo of a monoclonal antibody highly specific for fPSA in LNCaP cells. Hence, in vivo imaging of fPSA may be feasible with putative usefulness in disseminated PCa.
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Affiliation(s)
- Susan Evans-Axelsson
- Division of Urological Cancers, Department of Clinical Sciences, Lund University, Malmö, Sweden.
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Olbert P, Heinis J, Hofmann R, Hegele A. Das Cholin-PET/CT in der Primär- und Rezidivdiagnostik des Prostatakarzinoms. Urologe A 2012; 51:843-7. [DOI: 10.1007/s00120-012-2830-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Jambor I, Borra R, Kemppainen J, Lepomäki V, Parkkola R, Dean K, Alanen K, Arponen E, Nurmi M, Aronen HJ, Minn H. Improved detection of localized prostate cancer using co-registered MRI and 11C-acetate PET/CT. Eur J Radiol 2012; 81:2966-72. [PMID: 22342610 DOI: 10.1016/j.ejrad.2011.12.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 12/25/2011] [Accepted: 12/26/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We aimed to study the ability of contrast enhanced MRI at 1.5 T and 11C-acetate PET/CT, both individually and using fused data, to detect localized prostate cancer. METHODS Thirty-six men with untreated prostate cancer and negative for metastatic disease on pelvic CT and bone scan were prospectively enrolled. A pelvic 11C-acetate PET/CT scan was performed in all patients, and a contrast enhanced MRI scan in 33 patients (6 examinations using both endorectal coil and surface coils, and 27 examinations using surface coils only). After the imaging studies 10 patients underwent prostatectomy and 26 were treated by image guided external beam radiation treatment. Image fusion of co-registered PET and MRI data was performed based on anatomical landmarks visible on CT and MRI using an advanced in-house developed software package. PET/CT, MRI and fused PET/MRI data were evaluated visually and compared with biopsy findings on a lobar level, while a sextant approach was used for patients undergoing prostatectomy. RESULTS When using biopsy samples as method of reference, the sensitivity, specificity and accuracy for visual detection of prostate cancer on a lobar level by contrast enhanced MRI was 85%, 37%, 73% and that of 11C-acetate PET/CT 88%, 41%, 74%, respectively. Fusion of PET with MRI data increased sensitivity, specificity and accuracy to 90%, 72% and 85%, respectively. CONCLUSIONS Fusion of sequentially obtained PET/CT and MRI data for the localization of prostate cancer is feasible and superior to the performance of each individual modality alone.
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Affiliation(s)
- Ivan Jambor
- Department of Diagnostic Radiology, University of Turku, and Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.
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Van den Bergh L, Koole M, Isebaert S, Joniau S, Deroose CM, Oyen R, Lerut E, Budiharto T, Mottaghy F, Bormans G, Van Poppel H, Haustermans K. Is there an additional value of ¹¹C-choline PET-CT to T2-weighted MRI images in the localization of intraprostatic tumor nodules? Int J Radiat Oncol Biol Phys 2012; 83:1486-92. [PMID: 22284686 DOI: 10.1016/j.ijrobp.2011.10.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 10/10/2011] [Accepted: 10/23/2011] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the additional value of (11)C-choline positron emission tomography (PET)-computed tomography (CT) to T2-weighted (T2w) magnetic resonance imaging (MRI) for localization of intraprostatic tumor nodules. METHODS AND MATERIALS Forty-nine prostate cancer patients underwent T2w MRI and (11)C-choline PET-CT before radical prostatectomy and extended lymphadenectomy. Tumor regions were outlined on the whole-mount histopathology sections and on the T2w MR images. Tumor localization was recorded in the basal, middle, and apical part of the prostate by means of an octant grid. To analyze (11)C-choline PET-CT images, the same grid was used to calculate the standardized uptake values (SUV) per octant, after rigid registration with the T2w MR images for anatomic reference. RESULTS In total, 1,176 octants were analyzed. Sensitivity, specificity, and accuracy of T2w MRI were 33.5%, 94.6%, and 70.2%, respectively. For (11)C-choline PET-CT, the mean SUV(max) of malignant octants was significantly higher than the mean SUV(max) of benign octants (3.69 ± 1.29 vs. 3.06 ± 0.97, p < 0.0001) which was also true for mean SUV(mean) values (2.39 ± 0.77 vs. 1.94 ± 0.61, p < 0.0001). A positive correlation was observed between SUV(mean) and absolute tumor volume (Spearman r = 0.3003, p = 0.0362). No correlation was found between SUVs and prostate-specific antigen, T-stage or Gleason score. The highest accuracy (61.1%) was obtained with a SUV(max) cutoff of 2.70, resulting in a sensitivity of 77.4% and a specificity of 44.9%. When both modalities were combined (PET-CT or MRI positive), sensitivity levels increased as a function of SUV(max) but at the cost of specificity. When only considering suspect octants on (11)C-choline PET-CT (SUV(max) ≥ 2.70) and T2w MRI, 84.7% of these segments were in agreement with the gold standard, compared with 80.5% for T2w MRI alone. CONCLUSIONS The additional value of (11)C-choline PET-CT next to T2w MRI in detecting tumor nodules within the prostate is limited.
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Affiliation(s)
- Laura Van den Bergh
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
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Giovacchini G. Do we have to withdraw antiandrogenic therapy in prostate cancer patients before PET/CT with [11C]choline? Eur J Nucl Med Mol Imaging 2012; 38:1964-6. [PMID: 21901380 DOI: 10.1007/s00259-011-1926-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Skanjeti A, Pelosi E. Lymph Node Staging with Choline PET/CT in Patients with Prostate Cancer: A Review. ISRN ONCOLOGY 2011; 2011:219064. [PMID: 22220283 PMCID: PMC3246789 DOI: 10.5402/2011/219064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/13/2011] [Indexed: 11/23/2022]
Abstract
Due to its prevalence, prostate cancer represents a serious health problem. The treatment, when required, may be local in case of limited disease, locoregional if lymph nodes are involved, and systemic when distant metastases are present. In order to choose the best treatment regimen, an accurate disease staging is mandatory. However, the accuracy of conventional imaging modalities in detecting lymph node and bone metastases is low. In the last decade, molecular imaging, particularly, choline PET-CT has been evaluated in this setting. Choline PET represents the more accurate exam to stage high-risk prostate cancer, and it is useful in staging patients with biochemical relapse, in particular when PSA kinetics is high and/or PSA levels are more than 2 pg/ml. The present paper reports results of available papers on these issues, with particular attention to lymph node staging.
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Affiliation(s)
- Andrea Skanjeti
- SCDU Medicina Nucleare 2, ASO S. Giovanni Battista, Corso Bramante, 88, 10126 Torino, Italy
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Biological basis of [11C]choline-positron emission tomography in patients with breast cancer. Nucl Med Commun 2011; 32:997-1004. [DOI: 10.1097/mnm.0b013e328349567b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Emonds KM, Swinnen JV, van Weerden WM, Vanderhoydonc F, Nuyts J, Mortelmans L, Mottaghy FM. Do androgens control the uptake of 18F-FDG, 11C-choline and 11C-acetate in human prostate cancer cell lines? Eur J Nucl Med Mol Imaging 2011; 38:1842-53. [PMID: 21732108 DOI: 10.1007/s00259-011-1861-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 06/07/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the impact of androgen ablation therapy in different prostate cancer (PCa) cell lines--reflecting different stages of the disease--on (18)F-fluorodeoxyglucose (FDG), 11C-choline and 11C-acetate uptake. METHODS Uptake experiments were performed in androgen-sensitive (LNCaP, PC346C) and independent cell lines (22Rv1, PC346DCC, PC-3) as well as in a benign prostatic hyperplasia (BPH-1) cell line. Tracer uptake was assessed under androgen ablation. Results of the cancer cell lines were normalized to those of BPH-1. To evaluate the effect of androgen on the uptake of 18F-FDG, 11C-choline and 11C-acetate in PCa cell lines, 10(-8) M R1881, 10(-10) M R1881, the combination of 10(-10) M R1881 plus 10(-6) M Casodex or 10(-6) M Casodex alone were added in parallel cell cultures 1 day before uptake experiments. Uptake in androgen-supplemented cell cultures was compared to the uptake under androgen deprivation. Uptake was corrected for cell number using protein content. RESULTS Compared to BPH-1, a higher 18F-FDG uptake was observed only in PC346C cells, whereas a higher 11C-choline and markedly increased 11C-acetate uptake was seen in all cancer cell lines. Androgens significantly modulated the uptake of 18F-FDG in LNCaP, PC346C and 22Rv1 cells, and of 11C-choline in the PC346C and 22Rv1 cell line. No androgenic effect on 11C-choline and 18F-FDG uptake was observed in PC-3 and PC346DCC cells. 11C-Acetate uptake was independent of androgen status in all PCa cell lines studied. CONCLUSION 18F-FDG uptake in PCa cell lines showed the highest variability and strongest androgen effect, suggesting its poor potential for metabolic imaging of advanced PCa. In contrast to 18F-FDG and 11C-choline, 11C-acetate uptake was unaffected by androgens and thus 11C-acetate seems best for monitoring PCa progression.
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Affiliation(s)
- Kimy M Emonds
- Department of Nuclear Medicine, University Hospital Gasthuisberg Leuven, Leuven, Belgium
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Fuccio C, Schiavina R, Castellucci P, Rubello D, Martorana G, Celli M, Malizia C, Profitos MB, Marzola MC, Pettinato V, Fanti S. Androgen deprivation therapy influences the uptake of 11C-choline in patients with recurrent prostate cancer: the preliminary results of a sequential PET/CT study. Eur J Nucl Med Mol Imaging 2011; 38:1985-9. [PMID: 21732105 DOI: 10.1007/s00259-011-1867-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 06/13/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE The influence of androgen deprivation therapy (ADT) on (11)C-choline uptake in patients with prostate cancer (PC) has not yet been clarified. The aim of our study was to investigate this issue by means of sequential (11)C-choline positron emission tomography (PET)/CT in patients with recurrent PC. METHODS We retrospectively studied 14 recurrent PC patients (mean age 67 years, range 55-82) during follow-up after radical prostatectomy (RP) with rising serum prostate-specific antigen (PSA) levels. All patients had undergone at least two consecutive (11)C-choline PET/CT scans: the first (11)C-choline PET/CT before commencing ADT and the second (11)C-choline PET/CT after 6 months of ADT administration. RESULTS The mean serum PSA level before ADT was 17.0 ± 44.1 ng/ml. After 6 months of ADT administration the PSA value significantly decreased in comparison to baseline (PSA = 2.4 ± 3.1 ng/ml, p < .025). Moreover, before starting ADT, 13 of 14 patients had positive (11)C-choline PET/CT for metastatic spread, while after 6 months of ADT administration in 9 of 14 patients (11)C-choline PET/CT became negative. CONCLUSION These preliminary results suggest that ADT significantly reduces (11)C-choline uptake in androgen-sensitive PC patients.
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Affiliation(s)
- Chiara Fuccio
- Department of Nuclear Medicine, PAD. 30, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
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Souvatzoglou M, Weirich G, Schwarzenboeck S, Maurer T, Schuster T, Bundschuh RA, Eiber M, Herrmann K, Kuebler H, Wester HJ, Hoefler H, Gschwend J, Schwaiger M, Treiber U, Krause BJ. The sensitivity of [11C]choline PET/CT to localize prostate cancer depends on the tumor configuration. Clin Cancer Res 2011; 17:3751-9. [PMID: 21493868 DOI: 10.1158/1078-0432.ccr-10-2093] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the dependency of the sensitivity of [(11)C]choline positron emission tomography/computed tomography (PET/CT) for detecting and localizing primary prostate cancer (PCa) on tumor configuration in the histologic specimen. EXPERIMENTAL DESIGN Forty-three patients with biopsy-proven PCa were included. They underwent radical prostatectomy within 31 days after [(11)C]choline PET/CT. The transaxial image slices and the histologic specimens were analyzed by comparing the respective slices. Maximum standardized uptake values (SUV(max)) were calculated in each segment and correlated with histopathology. The tumor configuration in the histologic specimen was grouped as: I, unifocal; II, multifocal; III, rind-like shaped; IV, size <5 mm. Data analysis included the investigation of detection of PCa by SUV(max), the assessment of the influence of potential contributing factors on tumor prediction, and the evaluation of whether SUV could discriminate cancer tissue from benign prostate hyperplasia (BPH), prostatitis, HGPIN (high-grade prostate intraepithelial neoplasm), or normal prostate tissue. General estimation equation models were used for statistical analysis. RESULTS Tumor configuration in histology was classified as I in 21 patients, as II in 9, as III in 5, and as IV in 8. The prostate segment involved by cancer is identified in 79% of the patients. SUV(max) was located in the same side of the prostate in 95% of patients. Tumor configuration was the only factor significantly negatively influencing tumor prediction (P < 0.001). PCa-SUV(max) (median SUV(max) = 4.9) was not significantly different from BPH-SUV (median SUV(max) = 4.5) and prostatitis-SUV (median SUV(max) = 3.9), P = 0.102 and P = 0.054, respectively. CONCLUSIONS The detection and localization of PCa in the prostate with [(11)C]choline PET/CT is impaired by tumor configuration. Additionally, in our patient population, PCa tissue could not be distinguished from benign pathologies in the prostate.
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Affiliation(s)
- Michael Souvatzoglou
- Department of Nuclear Medicine,Technische Universität München, München, Germany.
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Abstract
Prostate cancer is biologically and clinically a heterogeneous disease and its imaging evaluation will need to be tailored to the specific phases of the disease in a patient-specific, risk-adapted manner. We first present a brief overview of the natural history of prostate cancer before discussing the role of various imaging tools, including opportunities and challenges, for different clinical phases of this common disease in men. We then review the preclinical and clinical evidence on the potential and emerging role of positron emission tomography with various radiotracers in the imaging evaluation of men with prostate cancer.
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Affiliation(s)
- Hossein Jadvar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Jadvar H. Prostate cancer: PET with 18F-FDG, 18F- or 11C-acetate, and 18F- or 11C-choline. J Nucl Med 2010; 52:81-9. [PMID: 21149473 DOI: 10.2967/jnumed.110.077941] [Citation(s) in RCA: 211] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer is biologically and clinically a heterogeneous disease that makes imaging evaluation challenging. The role of imaging in prostate cancer should include diagnosis, localization, and characterization (indolent vs. lethal) of the primary tumor, determination of extracapsular spread, guidance and evaluation of local therapy in organ-confined disease, staging of locoregional lymph nodes, detection of locally recurrent and metastatic disease in biochemical relapse, planning of radiation treatment, prediction and assessment of tumor response to salvage and systemic therapy, monitoring of active surveillance and definition of a trigger for definitive therapy, and prognostication of time to hormone refractoriness in castrate disease and overall survival. To address these tasks effectively, imaging needs to be tailored to the specific phases of the disease in a patient-specific, risk-adjusted manner. In this article, I review the preclinical and clinical evidence on the potential and emerging role of PET with the 3 most commonly studied radiotracers in prostate cancer, namely 18F-FDG, 18F- or 11C-acetate, and 18F- or 11C-choline.
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Affiliation(s)
- Hossein Jadvar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Beheshti M, Imamovic L, Broinger G, Vali R, Waldenberger P, Stoiber F, Nader M, Gruy B, Janetschek G, Langsteger W. 18F choline PET/CT in the preoperative staging of prostate cancer in patients with intermediate or high risk of extracapsular disease: a prospective study of 130 patients. Radiology 2010; 254:925-33. [PMID: 20177103 DOI: 10.1148/radiol.09090413] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the potential value of fluorocholine (FCH) positron emission tomography (PET)/computed tomography (CT) in the preoperative staging of patients with prostate cancer who had intermediate or high risk of extracapsular disease. MATERIALS AND METHODS Institutional review board approval and written informed consent were obtained. Overall, 132 patients with prostate cancer (mean age, 63 years +/- 7 [standard deviation]) were enrolled between October 2003 and June 2008. Two patients were subsequently excluded. In 111 patients, radical prostatectomy with extended pelvic lymph node (LN) dissection was performed. Patients were categorized into groups with intermediate (n = 47) or high (n = 83) risk of extracapsular extension on the basis of their Gleason scores and prostate specific antigen levels. Imaging was performed with an integrated PET/CT system after injection of 4.07 MBq FCH per kilogram of body weight with acquisition of dynamic images in the pelvis and whole-body images. Statistical analysis was performed on a per-patient basis. RESULTS Significant correlation was found between sections with the highest FCH uptake and sextants with maximal tumor infiltration (r = 0.68; P = .0001). Overall, 912 LNs were histopathologically examined. A per-patient analysis revealed the sensitivity, specificity, and positive and negative predictive values of FCH PET/CT in the detection of malignant LNs were 45%, 96%, 82%, and 83%, respectively. For LN metastases greater than or equal to 5 mm in diameter, sensitivity, specificity, and positive and negative predictive values were 66%, 96%, 82%, and 92%, respectively. In 13 patients, 43 bone metastases were detected. Early bone marrow infiltration was detected with only FCH PET in two patients. FCH PET/CT led to a change in therapy in 15% of all patients and 20% of high-risk patients. CONCLUSION FCH PET/CT could be useful in the evaluation of patients with prostate cancer who are at high risk for extracapsular disease, and it could be used to preoperatively exclude distant metastases. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090413/-/DC1.
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Affiliation(s)
- Mohsen Beheshti
- Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St Vincent's Hospital, Seilerstaette 4, A-4020 Linz, Austria.
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Li MM, Rybalov M, Haider MA, de Jong IJ. Does computed tomography or positron emission tomography/computed tomography contribute to detection of small focal cancers in the prostate? J Endourol 2010; 24:693-700. [PMID: 20367444 DOI: 10.1089/end.2009.0470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Prostate cancer is considered to be a multifocal tumor in the majority of patients. Based on histologic data after prostatectomy, there is a growing insight that a considerable number of men who receive a diagnosis in the contemporary setting of prostate-specific antigen screening have unilateral or unifocal disease. With this, the current concept of whole-gland therapy has come into discussion. The need for improvement of intraprostatic tumor characterization is clear. Molecular imaging is one of the areas of research on this aspect. The clinical indications for positron emission tomography (PET)/CT have increased rapidly in the field of oncology and are largely based on fluorodeoxyglucose (FDG) PET. Both conventional CT and FDG PET, however, cannot detect prostate cancer foci <5 mm within the prostate. Dynamic contrast-enhanced CT involves imaging a region of interest rapidly (usually <10 seconds between images) during a bolus intravenous injection of a contrast agent. Through analysis of the contrast enhancement time curves, it is possible to distinguish tissues with different microvascular properties such as cancer. The technologic aspects of both imaging techniques and the clinical results of 11C-choline PET/CT for intraprostatic tumor characterization are discussed. Based on preliminary studies, dynamic contrast-enhanced (DCE)-CT may be a useful tool for localization of prostate tumors and, perhaps more importantly, quantification of therapeutic response in prostate cancer. Validation work is necessary, however, to define its accuracy and role in therapeutic paradigms such as focal therapies, particularly given the current accuracy of MRI. In the future, combining DCE-CT with CT or (11)C-choline PET/CT may be an alternative to MRI, offering a combination of quantitative parameters that may correlate to tumor prognosis as well as cancer localization for focal therapy.
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Affiliation(s)
- Michael M Li
- Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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