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de Kouchkovsky I, Aggarwal R, Hope TA. Prostate-specific membrane antigen (PSMA)-based imaging in localized and advanced prostate cancer: a narrative review. Transl Androl Urol 2021; 10:3130-3143. [PMID: 34430416 PMCID: PMC8350242 DOI: 10.21037/tau-20-1047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022] Open
Abstract
Combined molecular and morphologic imaging modalities have emerged in recent years as an alternative to conventional imaging in prostate cancer (PC). In particular, novel prostate-specific membrane antigen (PSMA) radiotracers have demonstrated increased sensitivity and specificity for the initial staging of men with clinically localized PC, as well as for PC detection in the setting of biochemical recurrence (BCR). Molecular imaging is increasingly used to guide treatment decisions in these patients—though its impact on survival has yet to be established. Improved PC detection in men with BCR has also helped to identify a subset of patients with oligometastatic disease. The optimal management of oligometastatic PC and the role of metastasis-directed therapies (MDT) are the subjects of ongoing studies. In comparison to clinically localized or biochemically recurrent PC, the role of molecular imaging in men with advanced disease is less established. In metastatic castration-resistant PC (mCRPC), PSMA-based imaging has primarily been investigated as a companion diagnostic tool to predict and monitor response to PSMA-targeted radioligand therapy (RLT). More recent efforts have focused on using molecular imaging to monitor treatment response to conventional chemohormonal therapies. However, despite promising early results, several barriers remain to the widespread use of PSMA-based imaging in metastatic PC: temporary flares in PSMA uptake have been described in a subset of patients after initiation of therapy, and the underlying mechanism and clinical implications of this phenomenon are still poorly understood. Furthermore, whereas PSMA is invariably expressed in hormone-sensitive PC, loss of PSMA expression is increasingly recognized in a subset of mCRPC patients with aggressive disease. Although this may limit the use of PSMA-based imaging as a standalone modality in advanced PC, loss of PSMA uptake may also provide non-invasive and clinically relevant molecular insight on patients’ underlying tumor biology.
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Affiliation(s)
- Ivan de Kouchkovsky
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Rahul Aggarwal
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Thomas A Hope
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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2
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Vatsa R, Kumar R, Shukla J, Rana N, Vadi SK, Lal A, Singh SK, Mittal BR. F-18 fluorocholine positron emission tomography- computed tomography in initial staging and recurrence evaluation of prostate carcinoma: A prospective comparative study with diffusion-weighted magnetic resonance imaging and whole-body skeletal scintigraphy. World J Nucl Med 2021; 20:156-163. [PMID: 34321968 PMCID: PMC8286002 DOI: 10.4103/wjnm.wjnm_46_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/30/2020] [Accepted: 09/26/2020] [Indexed: 11/04/2022] Open
Abstract
Prostate cancer (PCa) is one of the major causes of death due to cancer in men. Conventional imaging modalities such as magnetic resonance imaging (MRI) provide locoregional status, but fall short in identifying distant metastasis. C-11 choline F-18 fluorocholine (F-18 FCH) has been shown to be useful in imaging of PCa. The present prospective study evaluates and compares the role of F-18 FCH positron emission tomography-computed tomography (PET-CT) with locoregional MRI and whole-body bone scintigraphy in PCa patients for initial staging and recurrence evaluation. This study included a total of 50 patients. Tc-99m skeletal scintigraphy, F-18 FCH PET-CT, and diffusion-weighted MRI of the pelvic region were performed within a span of 2-3 weeks of each other, in random order. For the primary site, core biopsy findings of the lesion were considered as gold standard. The kappa test was used to measure agreement between bone scintigraphy, F-18 FCH, and MRI. For comparing Tc-99m bone scintigraphy, F-18 FCH, and MRI, McNemar's test was applied. F-18 FCH PET-CT and MRI were able to detect primary lesion in all initial staging patients. The sensitivity and specificity of F-18 FCH PET-CT versus MRI were found to be 92.8% versus 89.2% and 100 versus 80%, respectively, for the recurrence at the primary site. A total of 55 bony lesions at distant sites were detected on F-18 FCH PET-CT in comparison to 43 bone lesions on whole-body bone scintigraphy. F-18 FCH PET/CT also detected additional lung lesions in 2 patients and abdominal lymph nodes in 12 patients. F-18 FCH PET-CT could detect primary lesions, local metastasis, bone metastasis, and distant metastasis in a single study and is also a useful modality in recurrence evaluation in PCa patients.
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Affiliation(s)
- Rakhee Vatsa
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit Kumar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaya Shukla
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nivedita Rana
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shelvin Kumar Vadi
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Incidental Finding of Intrathyroid Metastases of Prostatic Cancer on 18F-Choline PET/CT. Clin Nucl Med 2019; 44:e101-e103. [PMID: 30516690 DOI: 10.1097/rlu.0000000000002374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An 85-year-old man with a 2-year history of prostate cancer, treated with radiotherapy and hormonal therapy, presented increased prostatic-specific antigen levels. F-choline PET/CT showed focal prostatic uptake consistent with known local recurrence, increased uptake of 2 hypodense thyroid nodules and of 2 left cervical lymph nodes, suspected as thyroid cancer. Neck ultrasound confirmed the high risk of malignancy, and a guided biopsy (of a thyroid nodule and cervical lymph node) revealed cellular infiltrates thyroid transcription factor-1 (TTF-1) negative and prostatic-specific antigen positive, confirming intrathyroid and cervical lymph node metastases of prostate cancer. PET/CT changed the disease staging. Chemotherapy was initiated.
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4
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De Visschere PJ, Standaert C, Fütterer JJ, Villeirs GM, Panebianco V, Walz J, Maurer T, Hadaschik BA, Lecouvet FE, Giannarini G, Fanti S. A Systematic Review on the Role of Imaging in Early Recurrent Prostate Cancer. Eur Urol Oncol 2019; 2:47-76. [DOI: 10.1016/j.euo.2018.09.010] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 12/20/2022]
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5
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Samper Ots P, Luis Cardo A, Vallejo Ocaña C, Cabeza Rodríguez MA, Glaria Enríquez LA, Couselo Paniagua ML, Olivera Vegas J. Diagnostic performance of 18F-choline PET-CT in prostate cancer. Clin Transl Oncol 2018; 21:766-773. [DOI: 10.1007/s12094-018-1985-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
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6
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Wei J, Zhu H, Liao X. Trigger pSA predicting recurrence from positive choline PET/CT with prostate cancer after initial treatment. Oncotarget 2018; 9:14630-14641. [PMID: 29581869 PMCID: PMC5865695 DOI: 10.18632/oncotarget.24318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/13/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose To assess the relationship between the diagnostic accuracy of Choline positron emission tomography/computed tomography (PET/CT) and the trigger prostate-specific antigen (PSA) level in patients with a biochemical recurrence of prostate cancer. Materials and Methods A meta-analysis was conducted to synthesize data across multiple studies. Results The pooled sensitivity and specificity of choline PET/CT were 82% (95% Confidence Interval (CI):80-84%) and 92% (95%CI: 90-93%), respectively. The pooled sensitivity and specificity of 18F-choline PET/CT were 81% (95%CI: 78-84%) and 90% (95%CI: 85-93%), respectively. The pooled sensitivity and specificity of 11C-choline PET/CT were 83% (95% CI: 80-86%) and 92% (95% CI: 90-94%), respectively. The pooled detection rate of 18F-choline PET/CT and 11C-choline PET/CT were 58% (95% CI: 48-68%) and 58% (95%CI: 49-68%), respectively. Conclusions Trigger PSA is an important risk factor for positive findings of Choline PET/CT and the detection rate of Choline PET/CT for recurrent prostate cancer increased in parallel with raises in PSA-values. Choline PET/CT got higher detection rate while the trigger PSA > 2ng/ml.
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Affiliation(s)
- Junbao Wei
- Department of Therapeutic Radiology, Guangxi Autonomous Regional Cancer Hospital & Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Hengzong Zhu
- Department of General Medicine, Longan Hospital of Traditional Chinese Medicine, Nanning, 532700, China
| | - Xiaoli Liao
- The Oncology Department, Guangxi Autonomous Regional Cancer Hospital & Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
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Does Choline PET/CT Change the Management of Prostate Cancer Patients With Biochemical Failure? Am J Clin Oncol 2017; 40:256-259. [PMID: 25319322 DOI: 10.1097/coc.0000000000000139] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The FDA approved C-11 choline PET/computed tomography (CT) for imaging patients with recurrent prostate cancer in 2012. Subsequently, the 2014 NCCN guidelines have introduced labeled choline PET/CT in the imaging algorithm of patients with suspected recurrent disease. However, there is only scarce data on the impact of labeled choline PET/CT findings on disease management. We hypothesized that labeled-choline PET/CT studies showing local or regional recurrence or distant metastases will have a direct role in selection of appropriate patient management and improve radiation planning in patients with disease that can be controlled using this mode of therapy. METHODS This retrospective study was approved by the Tel Aviv Sourasky and Sheba Medical Center's Helsinki ethical review committees. Patient characteristics including age, PSA, stage, prior treatments, and pre-PET choline treatment recommendations based on NCCN guidelines were recorded. Patients with biochemical failure and without evidence of recurrence on physical examination or standard imaging were offered the option of additional imaging with labeled choline PET/CT. Treatment recommendations post-PET/CT were compared with pre-PET/CT ones. Pathologic confirmation was obtained before prostate retreatment. A nonparametric χ test was used to compare the initial and final treatment recommendations following choline PET/CT. RESULTS Between June 2010 and January 2014, 34 labeled-choline PET/CT studies were performed on 33 patients with biochemical failure following radical prostatectomy (RP) (n=6), radiation therapy (RT) (n=6), brachytherapy (n=2), RP+salvage prostate fossa RT (n=14), and RP+salvage prostate fossa/lymph node RT (n=6). Median PSA level before imaging was 2 ng/mL (range, 0.16 to 79). Labeled choline PET/CT showed prostate, prostate fossa, or pelvic lymph node increased uptake in 17 studies, remote metastatic disease in 9 studies, and failed to identify the cause for biochemical failure in 7 scans.PET/CT altered treatment approach in 18 of 33 (55%) patients (P=0.05). Sixteen of 27 patients (59%) treated previously with radiation were retreated with RT and delayed or eliminated androgen deprivation therapy: 1 received salvage brachytherapy, 10 received salvage pelvic lymph node or prostate fossa irradiation, 2 brachytherapy failures received salvage prostate and lymph nodes IMRT, and 3 with solitary bone metastasis were treated with radiosurgery. Eleven of 16 patients retreated responded to salvage therapy with a significant PSA response (<0.2 ng/mL), 2 patients had partial biochemical responses, and 3 patients failed. The median duration of response was 500±447 days. Two of 6 patients with no prior RT were referred for salvage prostatic fossa RT: 1 received dose escalation for disease identified in the prostate fossa and another had inclusion of "hot" pelvic lymph nodes in the treatment volume. CONCLUSIONS These early results suggest that labeled choline PET/CT imaging performed according to current NCCN guidelines may change management and improve care in prostate cancer patients with biochemical failure by identifying patients for referral for salvage radiation therapy, improving radiation planning, and delaying or avoiding use of androgen deprivation therapy.
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Logghe P, Verlinde R, Bouttens F, Van den Broecke C, Deman N, Verboven K, Maes D, Merckx L. Long term outcome and side effects in patients receiving low-dose I125 brachytherapy: a retrospective analysis. Int Braz J Urol 2017; 42:906-917. [PMID: 27532118 PMCID: PMC5066886 DOI: 10.1590/s1677-5538.ibju.2015.0542] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives: To retrospectively evaluate the disease free survival (DFS), disease specific survival (DSS),overall survival (OS) and side effects in patients who received low-dose rate (LDR) brachytherapy with I125 stranded seeds. Materials and methods: Between july 2003 and august 2012, 274 patients with organ confined prostate cancer were treated with permanent I125 brachytherapy. The median follow-up, age and pretreatment prostate specific antigen (iPSA) was 84 months (12-120), 67 years (50-83) and 7.8 ng/mL (1.14-38), respectively. Median Gleason score was 6 (3-9). 219 patients (80%) had stage cT1c, 42 patients (15.3%) had stage cT2a, 3 (1.1%) had stage cT2b and 3 (1.1%) had stage cT2c. The median D90 was 154.3 Gy (102.7-190.2). Results: DSS was 98.5%.OS was 93.5%. 13 patients (4.7%) developed systemic disease, 7 patients (2.55%) had local progression. In 139 low risk patients, the 5 year biochemical freedom from failure rate (BFFF) was 85% and 9 patients (6.4%) developed clinical progression. In the intermediate risk group, the 5 year BFFF rate was 70% and 5 patients (7.1%) developed clinical progression. Median nPSA in patients with biochemical relapse was 1.58 ng/mL (0.21 – 10.46), median nPSA in patients in remission was 0.51 ng/mL (0.01 – 8.5). Patients attaining a low PSA nadir had a significant higher BFFF (p<0.05). Median D90 in patients with biochemical relapse was 87.2 Gy (51 – 143,1). Patients receiving a high D90 had a significant higher BFFF (p<0.05). Conclusion: In a well selected patient population, LDR brachytherapy offers excellent outcomes. Reaching a low PSA nadir and attaining high D90 values are significant predictors for a higher DFS.
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Affiliation(s)
- Pieter Logghe
- Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Rolf Verlinde
- Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Frank Bouttens
- Department of Radiotherapy-Oncology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | | | - Nathalie Deman
- Department of Physics, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Koen Verboven
- Department of Physics, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Dirk Maes
- Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Luc Merckx
- Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
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Mapelli P, Incerti E, Ceci F, Castellucci P, Fanti S, Picchio M. 11C- or 18F-Choline PET/CT for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer. J Nucl Med 2017; 57:43S-48S. [PMID: 27694171 DOI: 10.2967/jnumed.115.169755] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/27/2016] [Indexed: 01/02/2023] Open
Abstract
Recurrence of prostate cancer is suspected when an increase in the prostate-specific antigen level is detected after radical treatment; the recurrence could be local relapse, distant relapse, or both. Differentiation between the two patterns of relapse is critical for choosing the proper treatment strategy. Choline PET/CT could be of help in discriminating patients with local, lymph node, and bone recurrences, thus having an impact on patient management.
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Affiliation(s)
- Paola Mapelli
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Elena Incerti
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Francesco Ceci
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Castellucci
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Picchio
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
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10
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Einspieler I, Rauscher I, Düwel C, Krönke M, Rischpler C, Habl G, Dewes S, Ott A, Wester HJ, Schwaiger M, Maurer T, Eiber M. Detection Efficacy of Hybrid 68Ga-PSMA Ligand PET/CT in Prostate Cancer Patients with Biochemical Recurrence After Primary Radiation Therapy Defined by Phoenix Criteria. J Nucl Med 2017; 58:1081-1087. [PMID: 28209912 DOI: 10.2967/jnumed.116.184457] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/24/2017] [Indexed: 01/04/2023] Open
Abstract
The aim of this retrospective study was to evaluate the detection rate of Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] (68Ga-PSMA ligand; PSMA is prostate-specific membrane antigen) PET/CT in patients with biochemical recurrent prostate cancer defined by Phoenix criteria after external-beam radiotherapy or brachytherapy as primary treatment. Methods: One hundred eighteen patients with a median prostate-specific antigen (PSA) of 6.4 ng/mL (range, 2.2-158.4 ng/mL; interquartile range, 4.2-10.2 ng/mL) were finally eligible for this retrospective analysis. Seventy-seven and 41 patients had been treated by external-beam radiotherapy or brachytherapy, respectively. Of the 118 patients, 45 were receiving androgen-deprivation therapy (ADT) within at least 6 mo before the PET/CT. The detection rates were stratified by PSA. The influence of primary Gleason score and ADT was assessed. Relationships between SUV and clinical as well as pathologic features in patients with positive findings were analyzed using univariate and multivariable linear regression models. Results: One hundred seven of 118 patients (90.7%) showed pathologic findings indicative for tumor recurrence in 68Ga-PSMA ligand PET/CT. The detection rates were 81.8% (36/44), 95.3% (41/43), and 96.8% (30/31) for PSA of 2 to <5, 5 to <10, and ≥10 ng/mL, respectively (P = 0.0377). 68Ga-PSMA ligand PET/CT indicated local recurrence in 68 of 107 patients (63.5%), distant lesions in 64 of 107 patients (59.8%), and local recurrence as well as distant lesions in 25 of 107 patients (23.4%). The detection rate was significantly higher in patients with ADT (97.7%) versus without ADT (86.3%, P = 0.0381), but independent from primary Gleason score ≥ 8 (92.0%) versus ≤ 7 (90.2%, P = 0.6346). SUVmax and SUVmean were significantly associated with PSA and ADT (P = 0.018 and 0.004 for SUVmax, respectively; P = 0.025 and 0.007 for SUVmean, respectively). Conclusion:68Ga-PSMA ligand PET/CT demonstrates high detection rates in patients with biochemical recurrence of prostate cancer after primary radiation therapy. The detection rate was positively associated to increasing PSA as well as concomitant ADT. 68Ga-PSMA ligand PET/CT enables discrimination of local versus metastatic disease and thus might have a crucial impact on further clinical management. A major limitation of this study is the lack of histopathologic proof in most patients.
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Affiliation(s)
- Ingo Einspieler
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany .,Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Charlotte Düwel
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Krönke
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gregor Habl
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabrina Dewes
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Armin Ott
- Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany; and
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Johnson AC, Dugué AE, Silva M, Moise L, Tillou X, Joly F, Aide N. Predictive factors of 18F-choline PET/CT positivity in patients with prostate cancer recurrence after radiation therapy: is the impact of PSA nadir underestimated? EJNMMI Res 2016; 6:84. [PMID: 27873241 PMCID: PMC5118229 DOI: 10.1186/s13550-016-0237-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study is to explore the impact of PSA nadirs on detection rates of prostate cancer (PCa) recurrence with 18F-choline (CH) PET/CT after external beam radiation therapy (EBRT). Methods In this retrospective study, data were collected from 54 patients with suspicion of PCa biochemical recurrence after EBRT (28 patients treated initially with EBRT and 26 as salvage therapy in the absence of PSA decrease after initial treatment), who underwent 18F-CH PET/CT between 2010 and 2015. PSA nadir and trigger PSA were collected from patient files. Relative PSA was calculated by subtracting the nadir from the trigger PSA. Results Median PSA nadir was 0.31 (0.01–13.31) ng/mL, trigger PSA was 7.85 (0.47–111.60) ng/mL, and relative PSA was 6.05 (0.24–104.59) ng/mL. Overall, 40 (74%) PET/CT scans were positive: recurrence was local and/or regional in 29 patients, distant in 15 and combined both in four, with no association between PSA values and sites of recurrence. In univariate analysis, trigger (p = 0.015) and relative (p = 0.0005) PSA values and PSA velocity (p = 0.01) were significantly linked to positive PET/CT, but PSA nadir was not. In subgroup analysis, these significant differences were only found in the salvage EBRT group. Akaike Information Criterion multivariate model comparison found that relative PSA was a better predictor of positive PET/CT than trigger PSA (PSAt). 18F-CH PET/CT detection rates increased with trigger and relative PSA: 0% (0/4 patients), 71% (5/7 patients), and 81% (35/43 patients) for PSAt <2 ng/mL, 2≤ PSAt ≤4 ng/mL, and PSAt >4 ng/mL, respectively, and 14% (1/7 patients), 50% (5/10 patients), and 92% (34/37 patients) when relative PSA was taken into account instead of trigger PSA, with seven (13%) patients changing subgroups. Conclusions We found a high overall detection rate and an increase in detection rates proportional to trigger and relative PSAs. Although relative PSA, taking into account PSA nadir, was a better predictive factor of PET/CT positivity in univariate analysis, this was most noticeable for high PSAs. For low PSAs, trigger PSA remains most relevant. Larger series with intermediate PSA values need to be studied to fully apprehend nadir impact.
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Affiliation(s)
- Alison C Johnson
- Department of Oncology, François Baclesse Cancer Center, Caen, France
| | | | - Marlon Silva
- Department of Radiation Therapy, François Baclesse Cancer Center, Caen, France
| | - Laura Moise
- Department of Oncology, François Baclesse Cancer Center, Caen, France
| | - Xavier Tillou
- Department of Urology, University Hospital of Caen, Caen, France
| | - Florence Joly
- Department of Oncology, François Baclesse Cancer Center, Caen, France
| | - Nicolas Aide
- Department of Nuclear Medicine, University Hospital of Caen, Caen, France. .,Department of Nuclear Medicine, François Baclesse Cancer Center, Caen, France.
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12
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Grubmüller B, Baum RP, Capasso E, Singh A, Ahmadi Y, Knoll P, Floth A, Righi S, Zandieh S, Meleddu C, Shariat SF, Klingler HC, Mirzaei S. 64Cu-PSMA-617 PET/CT Imaging of Prostate Adenocarcinoma: First In-Human Studies. Cancer Biother Radiopharm 2016; 31:277-286. [PMID: 27715146 DOI: 10.1089/cbr.2015.1964] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The prostate-specific membrane antigen (PSMA) is a cell surface protein, which is overexpressed in nearly all cases of prostate cancer (PCa). PET imaging with 68Ga-PSMA-HBED-CC has recently found widespread application in the diagnosis of recurrent PCa. In this study, the diagnostic potential of 64Cu-labeled PSMA ligand (PSMA-617) PET in patients with PCa has been investigated. MATERIALS AND METHODS The study was conducted simultaneously at two nuclear medicine centers, Austria (Vienna, Center 1) and Germany (Bad Berka, Center 2). The patients (n = 29) included in this study were referred for PET (Center 1, 21 patients) or PET/CT (Center 2, 8 patients) imaging with either a high suspicion of recurrent disease or for possible surgical or PSMA radioligand therapy planning. PET images of the whole body were performed at 1 hour p.i. and additional images of the pelvis at 2 hours p.i. RESULTS In 23 of 29 patients, at least one focus of pathological tracer uptake suspicious for primary disease in the prostate lobe or recurrent disease was detected. Among healthy organs, the salivary glands, kidneys, and liver showed the highest radiotracer uptake. Lesions suspicious for PCa were detected with excellent contrast as early as 1 hour p.i. with high detection rates even at low prostate-specific antigen (PSA) levels. CONCLUSION The preliminary results of this study demonstrate the high potential of 64Cu-PSMA ligand PET/CT imaging in patients with recurrent disease and in the primary staging of selected patients with progressive local disease. The acquired PET images showed an excellent resolution of the detected lesions with very high lesion-to- background contrast. Furthermore, the long half-life of 64Cu allows distribution of the tracer to clinical PET centers that lack radiochemistry facilities for the preparation of 68Ga-PSMA ligand (satellite concept).
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Affiliation(s)
- Bernhard Grubmüller
- 1 Department of Urology, Vienna General Hospital, Medical University of Vienna , Vienna, Austria
| | - Richard P Baum
- 2 THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT), ENETS Center of Excellence , Zentralklinik Bad Berka, Bad Berka, Germany
| | - Enza Capasso
- 3 Regional Oncological Hospital , U.O.C. Nuclear Medicine, Cagliari, Italy
| | - Aviral Singh
- 2 THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging (PET/CT), ENETS Center of Excellence , Zentralklinik Bad Berka, Bad Berka, Germany
| | - Yasaman Ahmadi
- 4 Institute of Nuclear Medicine with PET Center , Wilhelminenspital Vienna, Vienna, Austria
| | - Peter Knoll
- 4 Institute of Nuclear Medicine with PET Center , Wilhelminenspital Vienna, Vienna, Austria
| | - Andreas Floth
- 5 Department of Urology, Wilhelminenspital Vienna , Vienna, Austria
| | - Sergio Righi
- 6 Dirigente Fisico Sanitario , S.C. Fisica Sanitaria, E.O. Ospedali Galliera, Genova, Italy
| | - Shahin Zandieh
- 7 Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of the Medical University of Vienna , Vienna, Austria
| | - Carlo Meleddu
- 3 Regional Oncological Hospital , U.O.C. Nuclear Medicine, Cagliari, Italy
| | - Shahrokh F Shariat
- 1 Department of Urology, Vienna General Hospital, Medical University of Vienna , Vienna, Austria
| | | | - Siroos Mirzaei
- 4 Institute of Nuclear Medicine with PET Center , Wilhelminenspital Vienna, Vienna, Austria
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A Retrospective Feasibility Study of Salvage Pelvic Nodal Radiation in 6 Patients With Biochemical Failure Following Prostate Fossa Radiation. Am J Clin Oncol 2016; 39:479-483. [DOI: 10.1097/coc.0000000000000079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Behrendt FF, Lensing C, Keil S, Mottaghy FM, Verburg FA. No clinically relevant differences between positron emission tomography (PET) reconstructions based on low-dose or contrast-enhanced CT in combined integrated multiphase 18F-Fluorethylcholine PET/CT for prostate cancer. J Med Imaging Radiat Oncol 2016; 60:498-505. [DOI: 10.1111/1754-9485.12481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 04/30/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Florian F Behrendt
- Department of Nuclear Medicine; RWTH Aachen University Hospital; Aachen Germany
- Radiology Institute ‘Aachen Land’; Würselen Germany
| | - Carina Lensing
- Department of Nuclear Medicine; RWTH Aachen University Hospital; Aachen Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology; RWTH Aachen University Hospital; Aachen Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine; RWTH Aachen University Hospital; Aachen Germany
- Department of Nuclear Medicine; Maastricht University Medical Center; Maastricht The Netherlands
| | - Frederik A Verburg
- Department of Nuclear Medicine; RWTH Aachen University Hospital; Aachen Germany
- Department of Nuclear Medicine; Maastricht University Medical Center; Maastricht The Netherlands
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15
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Amzalag G, Rager O, Tabouret-Viaud C, Wissmeyer M, Sfakianaki E, de Perrot T, Ratib O, Miralbell R, Giovacchini G, Garibotto V, Zilli T. Target Definition in Salvage Radiotherapy for Recurrent Prostate Cancer: The Role of Advanced Molecular Imaging. Front Oncol 2016; 6:73. [PMID: 27065024 PMCID: PMC4814800 DOI: 10.3389/fonc.2016.00073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/14/2016] [Indexed: 12/28/2022] Open
Abstract
Salvage radiotherapy (SRT) represents the main treatment option for relapsing prostate cancer in patients after radical prostatectomy. Several open questions remain unanswered in terms of target volumes definition and delivered doses for SRT: the effective dose necessary to achieve biochemical control in the SRT setting may be different if the tumor recurrence is micro- or macroscopic. At the same time, irradiation of only the prostatic bed or of the whole pelvis will depend on the localization of the recurrence, local or locoregional. In the “theragnostic imaging” era, molecular imaging using positron emission tomography (PET) constitutes a useful tool for clinicians to define the site of the recurrence, the extent of disease, and individualize salvage treatments. The best option currently available in clinical routine is the combination of radiolabeled choline PET imaging and multiparametric magnetic resonance imaging (MRI), associating the nodal and distant metastases identification based on PET with the local assessment by MRI. A new generation of targeted tracers, namely, prostate-specific membrane antigen, show promising results, with a contrast superior to choline imaging and a higher detection rate even for low prostate-specific antigen levels; validation studies are ongoing. Finally, imaging targeting bone remodeling, using whole-body SPECT–CT, is a relevant complement to molecular/metabolic PET imaging when bone involvement is suspected.
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Affiliation(s)
- Gaël Amzalag
- Division of Nuclear Medicine, Hospital of Neuchâtel, Neuchâtel, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Olivier Rager
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital , Geneva , Switzerland
| | - Claire Tabouret-Viaud
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital , Geneva , Switzerland
| | - Michael Wissmeyer
- Division of Nuclear Medicine, Hospital of Neuchâtel, Neuchâtel, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Electra Sfakianaki
- Division of Radiology, Geneva University Hospital , Geneva , Switzerland
| | - Thomas de Perrot
- Division of Radiology, Geneva University Hospital , Geneva , Switzerland
| | - Osman Ratib
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Raymond Miralbell
- Faculty of Medicine, Geneva University, Geneva, Switzerland; Division of Radiation-Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Giampiero Giovacchini
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli , Zurich , Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Thomas Zilli
- Faculty of Medicine, Geneva University, Geneva, Switzerland; Division of Radiation-Oncology, Geneva University Hospital, Geneva, Switzerland
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16
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Salvage Brachytherapy for Biochemically Recurrent Prostate Cancer following Primary Brachytherapy. Prostate Cancer 2016; 2016:9561494. [PMID: 27092279 PMCID: PMC4820628 DOI: 10.1155/2016/9561494] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/22/2016] [Accepted: 02/22/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. In this study, we evaluated our experience with salvage brachytherapy after discovery of biochemical recurrence after a prior brachytherapy procedure. Methods and Materials. From 2001 through 2012 twenty-one patients treated by brachytherapy within University of Kentucky or from outside centers developed biochemical failure and had no evidence of metastases. Computed tomography (CT) scans were evaluated; patients who had an underseeded portion of their prostate were considered for reimplantation. Results. The majority of the patients in this study (61.9%) were low risk and median presalvage PSA was 3.49 (range 17.41-1.68). Mean follow-up was 61 months. At last follow-up after reseeding, 11/21 (52.4%) were free of biochemical recurrence. There was a trend towards decreased freedom from biochemical recurrence in low risk patients (p = 0.12). International Prostate Symptom Scores (IPSS) increased at 3-month follow-up visits but decreased and were equivalent to baseline scores at 18 months. Conclusions. Salvage brachytherapy after primary brachytherapy is possible; however, in our experience the side-effect profile after the second brachytherapy procedure was higher than after the first brachytherapy procedure. In this cohort of patients we demonstrate that approximately 50% oncologic control, low risk patients appear to have better outcomes than others.
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17
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Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with 68Ga-PSMA-HBED-CC than with 18F-Fluoroethylcholine PET/CT. Eur J Nucl Med Mol Imaging 2016; 43:1410-7. [DOI: 10.1007/s00259-016-3366-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
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Abstract
Although many PET tracers are in use, FDG still is the most widely used in clinical oncology practice. FDG therefore deserves an in-depth discussion, which is even more interesting because of the huge increase in the molecular biology of glucose metabolism. Obviously, other tracers are of increasing importance as well, and these will be discussed in short.
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Affiliation(s)
- Dirk De Ruysscher
- Radiation Oncology, University Hospitals Leuven/KU Leuven, Louvain, Belgium.
- Maastricht University Medical Center, GROW, Maastro clinic, Louvain, Belgium.
| | - Karin Haustermans
- Radiation Oncology, University Hospitals Leuven/KU Leuven, Louvain, Belgium
| | - Daniela Thorwarth
- Section for Biomedical Physics, University Hospital for Radiation Oncology Tübingen, Tübingen, Germany
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18F-Choline PET/CT and Prostate MRI for Staging Patients With Biochemical Relapse After Irradiation for Prostate Cancer. Clin Nucl Med 2015; 40:e492-5. [DOI: 10.1097/rlu.0000000000000932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Rager O, Baskin A, Amzalag G, Buchegger F, Miralbell R, Ratib O, Zilli T, Garibotto V. Significance of 18F-fluorocholine PET/CT positive pulmonary lesions in prostate cancer patients. Nuklearmedizin 2015. [PMID: 26213186 DOI: 10.3413/nukmed-0737-15-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To assess the frequency and the significance of incidental pulmonary lesions with 18F-fluorocholine (18F-FCH) PET/CT in prostate cancer (PCa) patients. PATIENTS, METHODS 225 consecutive PCa patients referred for 18F-FCH PET/CT (median age 68 years) were retrospectively evaluated for the presence of lesions in the lungs: 173 referred for restaging and 52 for initial staging regarding their high risk of extra prostatic extension. The final diagnosis was based on histopathological or on clinical and radiological follow-up. RESULTS 13 patients had 18F-FCH positive pulmonary and 8 patients malignant lesions: 5 patients (38%) had a primary lung cancer (2 squamous cell carcinomas, 1 papillary adenocarcinoma, 1 typical pulmonary carcinoid, 1 bronchioloalveolar carcinoma) and 3 patients (23%) PCa metastases. Benign lesions were found in 5 subjects (38%). SUVmax and maximum diameter were neither significantly different in primary and metastatic tumors nor between malignant and benign lesions. CONCLUSIONS Although our results suggest that incidental uptake in the lungs in PCa patients are nonspecific, their detection may have a significant impact on patient management knowing that more than 60% represent malignant disease.
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Affiliation(s)
- O Rager
- Dr. Olivier Rager, Nuclear Medicine Department, Faculty of Medecine, University of Geneva, rue Gabrielle-Perret-Gentil, 4, 1211 Geneva, Switzerland, Tel. +41/223 72 71 44, Fax +41/223 72 71 69,
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21
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Abstract
PURPOSE OF REVIEW In the last 10 years, metastatic castration-resistant prostate cancer (mCRPC) treatment has completely changed. Several new agents have been shown to increase mCRPC patients' overall survival. The importance to define castration-resistant prostate cancer as metastatic and to enable earlier detection of cancer progression set a renewed role for prostate cancer (PCa) imaging. RECENT FINDINGS Recently published data on molecular imaging of metastatic PCa have focused on diagnostic accuracy, clinical impact and prognostic value of newer techniques using PET and MRI. SUMMARY Molecular imaging techniques are more sensitive and accurate than conventional imaging for the early detection of lymph node and bone metastases. New capabilities offered by PET imaging, MRI lymphography and whole-body MRI are consolidating the role of imaging in metastatic PCa management. These techniques are particularly useful for detecting metastasis, a driver for treatment initiation, especially in patients under androgen-deprivation therapy. Moreover, there is an increasing body of evidence supporting the use of metabolic PET and computed tomography as a prognostic biomarker able to predict survival in patients with metastatic PCa.
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Capasso E, Durzu S, Piras S, Zandieh S, Knoll P, Haug A, Hacker M, Meleddu C, Mirzaei S. Role of (64)CuCl 2 PET/CT in staging of prostate cancer. Ann Nucl Med 2015; 29:482-8. [PMID: 25833290 DOI: 10.1007/s12149-015-0968-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/23/2015] [Indexed: 12/01/2022]
Abstract
AIM The presence of an elevated copper concentration in cancer cells may be potentially used to differentiate healthy from transformed cells. In this study, we aimed to look at the possible role of (64)CuCl2 PET/CT in staging of patients with prostate cancer (PC). METHODS Seven patients affected by histologically confirmed PC have been prospectively enrolled. Three patients underwent adrenal deprivation therapy (ADT) at time of imaging. The remaining four patients had no ADT, surgery, or external beam radiation therapy (EBRT). In all patients, up to three (64)CuCl2 PET/CT scans 10 min, 1 h and 3 h (and an additional scan 24 h in 2 patients) after administration of mean 339 MBq (64)CuCl2 were performed and analyzed for presence of disease. Additionally, dosimetric calculations were performed. All patients underwent a multiparametric magnetic resonance imaging (mMRI) for confirmation of disease. RESULTS Lesions specifically in the pelvic area could be easily delineated, which was due to the absence of urinary excretion of the tracer. (64)CuCl2 uptake was higher in primary tumors of patients without ADT than in patients under bicalutamide therapy. In two patients with suspected lymphadenopathy at MRI (>10 mm diameter), there was no enhanced (64)CuCl2 uptake. In other two patients, there was focal enhanced uptake in involved pelvic lymph nodes, one of which with a normal size of <10 mm. CONCLUSIONS The preliminary results of this study show a high uptake of (64)CuCl2 in PC and involved regional lymph nodes indicating to a great potential of (64)CuCl2 PET/CT for primary staging of patients with prostate cancer.
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Affiliation(s)
- Enza Capasso
- Regional Oncological Hospital, U.O.C. Nuclear Medicine, Cagliari, Italy
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23
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Ng SJK, Sinha AK, Loi HY, Khor LK. Asymptomatic metastasis to cricoid from prostate carcinoma: an incidental finding detected on 18F-choline PET/CT. Jpn J Radiol 2015; 33:298-301. [DOI: 10.1007/s11604-015-0415-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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Giovacchini G, Incerti E, Mapelli P, Kirienko M, Briganti A, Gandaglia G, Montorsi F, Gianolli L, Picchio M. [¹¹C]Choline PET/CT predicts survival in hormone-naive prostate cancer patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging 2015; 42:877-84. [PMID: 25697127 DOI: 10.1007/s00259-015-3015-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/02/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Over the last decade, PET/CT with radiolabelled choline has been shown to be useful for restaging patients with prostate cancer (PCa) who develop biochemical failure. The limitations of most clinical studies have been poor validation of [(11)C]choline PET/CT-positive findings and lack of survival analysis. The aim of this study was to assess whether [(11)C]choline PET/CT can predict survival in hormone-naive PCa patients with biochemical failure. METHODS This retrospective study included 302 hormone-naive PCa patients treated with radical prostatectomy who underwent [(11)C]choline PET/CT from 1 December 2004 to 31 July 2007 because of biochemical failure (prostate-specific antigen, PSA, >0.2 ng/mL). Median PSA was 1.02 ng/mL. PCa-specific survival was estimated using Kaplan-Meier curves. Cox regression analysis was used to evaluate the association between clinicopathological variables and PCa-specific survival. The coefficients of the covariates included in the Cox regression analysis were used to develop a novel nomogram. RESULTS Median follow-up was 7.2 years (1.4 - 18.9 years). [(11)C]Choline PET/CT was positive in 101 of 302 patients (33%). Median PCa-specific survival after prostatectomy was 14.9 years (95% CI 9.7 - 20.1 years) in patients with positive [(11)C]choline PET/CT. Median survival was not achieved in patients with negative [(11)C]choline PET/CT. The 15-year PCa-specific survival probability was 42.4% (95% CI 31.7 - 53.1%) in patients with positive [(11)C]choline PET/CT and 95.5% (95% CI 93.5 - 97.5 %) in patients with negative [(11)C]choline PET/CT. In multivariate analysis, [(11)C]choline PET/CT (hazard ratio 6.36, 95% CI 2.14 - 18.94, P < 0.001) and Gleason score >7 (hazard ratio 3.11, 95% CI 1.11 - 8.66, P = 0.030) predicted PCa-specific survival. An internally validated nomogram predicted 15-year PCa-specific survival probability with an accuracy of 80%. CONCLUSION Positive [(11)C]choline PET/CT after biochemical failure predicts PCa-specific survival in hormone-naive PCa patients. Prospective studies are warranted to confirm our results before more extensive use of [(11)C]choline PET/CT for prognostic stratification of PCa patients.
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Affiliation(s)
- Giampiero Giovacchini
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli, Zurich, Switzerland
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Créhange G, Roach M, Martin É, Cormier L, Peiffert D, Cochet A, Chapet O, Supiot S, Cosset JM, Bolla M, Chung H. Salvage reirradiation for locoregional failure after radiation therapy for prostate cancer: Who, when, where and how? Cancer Radiother 2014; 18:524-34. [PMID: 25192626 DOI: 10.1016/j.canrad.2014.07.153] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/29/2014] [Indexed: 11/26/2022]
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26
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Cochet A, Kanoun S, Humbert O, Walker PM, Cormier L, Créhange G, Brunotte F. Quelle imagerie pour la prise en charge de la rechute biochimique du cancer de la prostate : TEP ou IRM ? Cancer Radiother 2014; 18:509-16. [DOI: 10.1016/j.canrad.2014.07.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 12/25/2022]
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27
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De Bari B, Alongi F, Lestrade L, Giammarile F. Choline-PET in prostate cancer management: The point of view of the radiation oncologist. Crit Rev Oncol Hematol 2014; 91:234-47. [DOI: 10.1016/j.critrevonc.2014.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 03/12/2014] [Accepted: 04/17/2014] [Indexed: 12/26/2022] Open
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Value of fused 18F-Choline-PET/MRI to evaluate prostate cancer relapse in patients showing biochemical recurrence after EBRT: preliminary results. BIOMED RESEARCH INTERNATIONAL 2014; 2014:103718. [PMID: 24877053 PMCID: PMC4022120 DOI: 10.1155/2014/103718] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/10/2014] [Indexed: 11/17/2022]
Abstract
Purpose. We compared the accuracy of 18F-Choline-PET/MRI with that of multiparametric MRI (mMRI), 18F-Choline-PET/CT, 18F-Fluoride-PET/CT, and contrast-enhanced CT (CeCT) in detecting relapse in patients with suspected relapse of prostate cancer (PC) after external beam radiotherapy (EBRT). We assessed the association between standard uptake value (SUV) and apparent diffusion coefficient (ADC). Methods. We evaluated 21 patients with biochemical relapse after EBRT. Patients underwent 18F-Choline-PET/contrast-enhanced (Ce)CT, 18F-Fluoride-PET/CT, and mMRI. Imaging coregistration of PET and mMRI was performed. Results. 18F-Choline-PET/MRI was positive in 18/21 patients, with a detection rate (DR) of 86%. DRs of 18F-Choline-PET/CT, CeCT, and mMRI were 76%, 43%, and 81%, respectively. In terms of DR the only significant difference was between 18F-Choline-PET/MRI and CeCT. On lesion-based analysis, the accuracy of 18F-Choline-PET/MRI, 18F-Choline-PET/CT, CeCT, and mMRI was 99%, 95%, 70%, and 85%, respectively. Accuracy, sensitivity, and NPV of 18F-Choline-PET/MRI were significantly higher than those of both mMRI and CeCT. On whole-body assessment of bone metastases, the sensitivity of 18F-Choline-PET/CT and 18F-Fluoride-PET/CT was significantly higher than that of CeCT. Regarding local and lymph node relapse, we found a significant inverse correlation between ADC and SUV-max. Conclusion. 18F-Choline-PET/MRI is a promising technique in detecting PC relapse.
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Abstract
CLINICAL/METHODICAL ISSUE A present goal is to improve detection and staging of prostate cancer using innovative imaging technology such as PET/MRI. STANDARD RADIOLOGICAL METHODS The modality of choice for detection of prostate cancer is multiparametric MRI. Furthermore, PET/CT is used, in particular, for the detection and staging of distant metastases and recurrent disease. For assessment of bone metastases, the method most commonly used is bone scintigraphy. METHODICAL INNOVATIONS The development of a simultaneous hybrid PET/MRI system is the last great "fusion" of the known cross-sectional image modalities. In addition, synthesis of new, innovative tracers such as (18)F-FACBC or (68)Ga-PSMA allows more specific detection of prostate cancer. PERFORMANCE Hybrid PET/MRI imaging has the potential to replace conventional imaging techniques in the future. ACHIEVEMENTS The method is just starting the broad application. Clinical studies must be expanded in order to substantiate the additional value of the method. PRACTICAL RECOMMENDATIONS Currently, there is still a low distribution situation, since it is a new and cost-intensive method. At the same time, there is still no consistent solution for reimbursement. The importance in practice first rises by clarifying the payment situation and further demonstration of the method's benefit by larger studies.
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Affiliation(s)
- M C Röthke
- Abteilung für onkologische Radiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 Heidelberg, Deutschland.
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Pattern of occult nodal relapse diagnosed with 18F-fluoro-choline PET/CT in prostate cancer patients with biochemical failure after prostate-only radiotherapy. Radiother Oncol 2014; 111:120-5. [DOI: 10.1016/j.radonc.2014.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/21/2014] [Accepted: 03/02/2014] [Indexed: 11/21/2022]
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Is the detection rate of 18F-choline PET/CT influenced by androgen-deprivation therapy? Eur J Nucl Med Mol Imaging 2014; 41:1293-300. [PMID: 24566948 DOI: 10.1007/s00259-014-2720-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/29/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate if the detection rate (DR) of (18)F-choline (18F-CH) PET/CT is influenced by androgen-deprivation therapy (ADT) in patients with prostate cancer (PC) already treated with radical intent and presenting biochemical relapse. MATERIALS AND METHODS We have retrospectively evaluated (18)F-CH PET/CT scans of 325 consecutive PC patients enrolled in the period November 2009 to December 2012 previously treated with radical intent and referred to our centre to perform (18)F-CH PET/CT for biochemical relapse. Two different groups of patients were evaluated. group A included the whole sample of 325 patients (mean age 70 years, range: 49-86) who presented trigger PSA between 0.1 and 80 ng/ml (mean 5.5 ng/ml), and group B included 187 patients (mean age 70 years, range 49-86) with medium-low levels of trigger PSA ranging between 0.5 and 5 ng/ml (mean PSA 2.1 ng/ml); group B was chosen in order to obtain a more homogeneous group of patients in terms of PSA values also excluding both very low and very high PSA levels avoiding the "a priori" higher probability of negative or positive PET scan, respectively. At the time of examination, 139 patients from group A and 72 patients from group B were under ADT: these patients were considered to be hormone-resistant PC patients because from their oncologic history (>18 months) an increase of PSA levels emerged despite the ongoing ADT. The relationship between (18)F-CH PET/CT findings and possible clinical predictors was investigated using both univariate and multivariate binary logistic regression analyses, including trigger PSA and ADT. RESULTS Considering the whole population, overall DR of (18)F-CH PET was 58.2 % (189/325 patients). In the whole sample of patients (group A), both at the univariate and multivariate logistic regression analysis, trigger PSA and ADT were significantly correlated with the DR of (18)F-CH PET (p < 0.05). Moreover, the DR in patients under ADT (mean PSA 7.8 ng/ml) was higher than in patients not under ADT (mean PSA 3.9 ng/ml), (DR was 70.5 % and 48.9 %, respectively; p < 0.001), therefore, demonstrating the existence of a significant correlation between the DR of (18)F-CH PET and ADT. In group B patients only trigger PSA resulted a reliable predictor of the (18)F-CH positivity, since ADT was not correlated to the DR of (18)F-CH PET (p = 0.061). Also in group B the DR of (18)F-CH PET in patients under ADT was higher than in patients not under ADT (65.3 % and 51.3 %, respectively) but the difference was not significant without a statistically significant correlation in the Mann Whitney test (p = 0.456) therefore, suggesting the lack of correlation between DR (18)F-CH PET/CT and ADT. CONCLUSION Similarly to previous published studies, in our series the overall DR of (18)F-CH PET/CT was 58 % and was significantly correlated to trigger PSA. The most important finding of the present study is that ADT does not negatively influence DR of (18)F-CH PET/CT in PC patients with biochemical relapse; therefore, it can be suggested that it is not necessary to withdraw ADT before performing (18)F-CH PET/CT.
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Chondrogiannis S, Marzola MC, Rubello D. Editorial Comment to Update on positron emission tomography for imaging of prostate cancer. Int J Urol 2014; 21:23-4. [DOI: 10.1111/iju.12264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sotirios Chondrogiannis
- Department of Nuclear Medicine; PET/CT Centre; Santa Maria della Misericordia Hospital; Rovigo Italy
| | - Maria Cristina Marzola
- Department of Nuclear Medicine; PET/CT Centre; Santa Maria della Misericordia Hospital; Rovigo Italy
| | - Domenico Rubello
- Department of Nuclear Medicine; PET/CT Centre; Santa Maria della Misericordia Hospital; Rovigo Italy
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Ceci F, Castellucci P, Graziani T, Schiavina R, Brunocilla E, Mazzarotto R, Ntreta M, Lodi F, Martorana G, Fanti S. 11C-choline PET/CT detects the site of relapse in the majority of prostate cancer patients showing biochemical recurrence after EBRT. Eur J Nucl Med Mol Imaging 2013; 41:878-86. [PMID: 24346416 DOI: 10.1007/s00259-013-2655-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the usefulness and the detection rate of (11)C-choline PET/CT in a population of patients with prostate cancer (PC), exclusively treated with external beam radiotherapy (EBRT) as primary treatment, who showed biochemical relapse. MATERIALS AND METHODS We enrolled 140 patients showing a serum PSA level >2 ng/mL (mean 8.6 ng/mL, median 5 ng/mL, range 2 - 60 ng/mL). All patients had been treated with EBRT to the prostate gland and prostatic fossa with doses ranging from 70 to 76 Gy in low-risk patients (T1/T2 and/or serum PSA <10 ng/mL) and escalating to >76 Gy (range 76 - 81 Gy) in high-risk patients (T3/T4 and/or serum PSA >10 ng/mL). Of the 140 patients, 53 were receiving androgen deprivation therapy at the time of the scan. All positive (11)C-choline PET/CT findings were validated by transrectal ultrasound-guided biopsy or at least 12 months of follow-up with contrast-enhanced CT, MR, bone scintigraphy or a repeated (11)C-choline PET/CT scan. The relationships between the detection rate of (11)C-choline PET/CT and the factors PSA level, PSA kinetics, Gleason score, age, time to relapse and SUV max in patients with positive findings were analysed. RESULTS (11)C-Choline PET/CT detected the site of relapse in 123 of the 140 patients with a detection rate of 87.8 % (46 patients showed local relapse, 31 showed local and distant relapse, and 46 showed only distant relapse). In patients with relapse the mean serum PSA level was 9.08 ng/mL (median 5.1 ng/mL, range 2 - 60 ng/mL), the mean PSA doubling time was 5.6 months (median 3.5 months, range 0.4 - 48 months), and the mean PSA velocity was 15 ng/mL/year (median 8.8 ng/mL/year, range 0.4 - 87 ng/mL/year). Of the 123 patients with relapse, 77 (62.6 %) showed distant relapse with/without local relapse, and of these 77, 31 (40.2 %) showed oligometastatic disease (one or two distant lesions: lymph node lesions only in 16, bone lesions only in 14, and lymph node lesions and bone lesions in 1). In univariate and multivariate analyses PSA kinetics was the only variable affecting (11)C-choline PET/CT detection rate. A significant correlation between PSA kinetics and site of recurrence (local relapse only vs. distant metastasis) was also observed. CONCLUSION The detection rate of (11)C-choline PET/CT in patients with PC showing biochemical recurrence after EBRT as primary treatment is relatively high (87.8 %). (11)C-Choline PET/CT was able to detect extraprostatic disease in the 62.6 % of patients. Considering this high detection rate, (11)C-choline PET/CT could have clinical usefulness in the management of these PC patients, but this should be confirmed in future studies.
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Affiliation(s)
- Francesco Ceci
- Service of Nuclear Medicine, Policlinico S. Orsola Malpighi, University of Bologna, Bologna, Italy
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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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Kitajima K, Murphy RC, Nathan MA, Sugimura K. Update on positron emission tomography for imaging of prostate cancer. Int J Urol 2013; 21:12-23. [PMID: 23991644 DOI: 10.1111/iju.12250] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/10/2013] [Indexed: 12/11/2022]
Abstract
Prostate cancer is the most common non-cutaneous malignancy among men in the Western world, and continues to be a major health problem. Imaging has recently become more important in the clinical management of prostate cancer patients, including diagnosis, staging, choice of optimal treatment strategy, treatment follow up and restaging. Positron emission tomography, a functional and molecular imaging technique, has opened a new field in clinical oncological imaging. The most common positron emission tomography radiotracer, 18F-fluorodeoxyglucose, has been limited in imaging of prostate cancer. Recently, however, other positron emission tomography tracers, such as 11C-acetate and 11C- or (18) F-choline, have shown promising results. In the present review article, we overview the potential and current use of positron emission tomography or positron emission tomography/computed tomography imaging employing the four most commonly used positron emission tomography radiotracers, 18F-fluorodeoxyglucose, 11C-acetate and 11C- or 18F-choline, for imaging evaluation of prostate cancer.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University School of Medicine, Kobe, Japan
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