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De Giorgi U, Caroli P, Scarpi E, Conteduca V, Burgio SL, Menna C, Moretti A, Galassi R, Rossi L, Amadori D, Paganelli G, Matteucci F. (18)F-Fluorocholine PET/CT for early response assessment in patients with metastatic castration-resistant prostate cancer treated with enzalutamide. Eur J Nucl Med Mol Imaging 2015; 42:1276-83. [PMID: 25808631 DOI: 10.1007/s00259-015-3042-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/08/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE We investigated the role of (18)F-methylcholine (FCH) PET/CT in the early evaluation of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with enzalutamide. METHODS The study group comprised 36 patients with a median age of 72 years (range 48-90 years) who were treated with enzalutamide 160 mg once daily after at least one chemotherapeutic regimen with docetaxel. Patients were evaluated monthly for serological prostate-specific antigen (PSA) response. FCH PET/CT was performed at baseline and repeated after 3-6 weeks. Univariate and multivariate Cox regression models addressed potential predictors of progression-free survival (PFS) and overall survival (OS). RESULTS At a median follow-up of 24.2 months (range 1.8-27.3 months), 34 patients were evaluable for early FCH PET/CT evaluation of response, and of these 17 showed progressive disease (PD) and 17 had stable disease or a partial response. A decrease in PSA level of more than 50% was observed in 21 patients. Early FCH PET/CT PD predicted radiological PD 3 months in advance of CT in 12 of 18 patients (66%) and was discordant with the decrease in PSA level in 13 patients. In 6 of these, biochemical PD was confirmed in 2 months. In multivariate analysis, only decrease in PSA level and FCH PET/CT were significant predictors of PFS (p = 0.0005 and p = 0.029, respectively), whereas decrease in PSA level alone was predictive of OS (p = 0.007). CONCLUSION This is one of the first studies to evaluate the role of FCH PET/CT as an early predictor of outcome in mCRPC patients treated with enzalutamide. Our preliminary results suggest that the combination of FCH PET/CT and decrease in PSA level could be a valid tool to predict PFS in mCRPC patients. PSA remains the single most important prognostic factor, while FCH PET/CT does not add more information on OS beyond that obtained from PSA. Further studies in larger populations are needed to confirm these data and to clarify the role of FCH PET/CT in predicting response to enzalutamide in mCRPC patients.
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Affiliation(s)
- Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via Maroncelli 40, 47014, Meldola, Italy,
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Treglia G, Vigneri C, Sadeghi R, Evangelista L, Ceriani L, Giovanella L. Discordance rate between radiolabelled choline PET/CT and bone scintigraphy in detecting bone metastases in patients with prostate cancer: a meta-analysis. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0107-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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De Giorgi U, Caroli P, Burgio SL, Menna C, Conteduca V, Bianchi E, Fabbri F, Carretta E, Amadori D, Paganelli G, Matteucci F. Early outcome prediction on 18F-fluorocholine PET/CT in metastatic castration-resistant prostate cancer patients treated with abiraterone. Oncotarget 2014; 5:12448-58. [PMID: 25504434 PMCID: PMC4322993 DOI: 10.18632/oncotarget.2558] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/01/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE We investigated the role of 18F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT) in the early evaluation of abiraterone and outcome prediction in patients with metastatic castration-resistant prostate cancer (CRPC). PATIENT AND METHODS Forty-three patients with metastatic CRPC progressing after docetaxel received abiraterone 1,000 mg daily with prednisone 5 mg twice daily. Patients were evaluated monthly for serological PSA response and safety. FCH-PET/CT was done at baseline and after 3 to 6 weeks. Univariate and multivariate Cox regression models addressed potential predictors of progression-free survival (PFS) and overall survival (OS). RESULTS Declines in PSA level of ≥50% were seen in 21 of 43 (49%) patients. Forty-two patients were evaluable for FCH-PET/CT response. FCH-PET/CT bone flare was observed in 4 of 42 (10%) evaluable patients. In univariate analysis, PSA decline and FCH-PET/CT response predicted PFS, while PSA decline and FCH-PET/CT (progression vs non progression) predicted OS. In multivariate analysis, only FCH-PET/CT (progression vs nonprogression) remained significant for PFS and OS (p = 0.022 and p = 0.027, respectively). CONCLUSION Early FCH-PET/CT can predict clinical outcome in CRPC beyond PSA response. These data support further studies on FCH-PET/CT for abiraterone monitoring and outcome prediction in patients with CRPC.
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Affiliation(s)
- Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Paola Caroli
- Department of Nuclear Medicine, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Salvatore L. Burgio
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Cecilia Menna
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Vincenza Conteduca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Emanuela Bianchi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Francesca Fabbri
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Elisa Carretta
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Giovanni Paganelli
- Department of Nuclear Medicine, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
| | - Federica Matteucci
- Department of Nuclear Medicine, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) IRCCS, Meldola, Italy
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Imaging of castration-resistant prostrate cancer: development of imaging response biomarkers. Curr Opin Urol 2013; 23:230-6. [PMID: 23422587 DOI: 10.1097/mou.0b013e32835e9edc] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current standard for imaging castration-resistant prostate cancer (CRPC) focuses solely on detection. However, in order to assess treatment response, imaging must provide quantitative results that can be validated. RECENT FINDINGS Bone scintigraphy remains the most commonly used imaging tool for CRPC in bone, but with limited quantification capabilities. Both PET and MRI provide quantitative measures that could be used to assess treatment response. Several PET tracers have been shown to be able to detect bone metastases, but more research regarding their use for treatment response assessment is necessary. Similarly, research has shown that diffusion-weighted and dynamic contrast-enhanced MRI can detect metastases, with some studies suggesting that they may be suitable for assessing treatment response. SUMMARY Recent research has shown that many imaging techniques are able to successfully detect metastases in CRPC patients as well as or better than standard imaging. These imaging methods can also be applied to treatment response assessment; however, more research must be done to validate the quantitative measures before these techniques can be used clinically for assessing patients.
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Kitajima K, Murphy RC, Nathan MA. Choline PET/CT for imaging prostate cancer: an update. Ann Nucl Med 2013; 27:581-91. [PMID: 23632880 DOI: 10.1007/s12149-013-0731-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Abstract
Whole-body positron emission tomography/computed tomography (PET/CT) with [(11)C]- and [(18)F]-labeled choline derivates has emerged as a promising molecular imaging modality for the evaluation of prostate cancer. (11)C- and (18)F-choline PET/CT are used successfully for restaging prostate cancer in patients with biochemical recurrence of disease after definitive therapy, especially when the serum prostate-specific antigen level is >1.0 ng/mL. (11)C- and (18)F-choline PET/CT have more limited roles for the initial staging of prostate cancer and for the detection of tiny lymph node metastases due to the low spatial resolution inherent to PET. Overall, these modalities are most useful in patients with a high pre-test suspicion of metastatic disease. The following is a review of the current clinical roles of (11)C- and (18)F-choline PET/CT in the management of prostate cancer.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Kwee S, Song MA, Cheng I, Loo L, Tiirikainen M. Measurement of circulating cell-free DNA in relation to 18F-fluorocholine PET/CT imaging in chemotherapy-treated advanced prostate cancer. Clin Transl Sci 2012; 5:65-70. [PMID: 22376260 PMCID: PMC3500883 DOI: 10.1111/j.1752-8062.2011.00375.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: To examine the effects of chemotherapy on circulating cell‐free DNA (cfDNA) composition in relation to investigational whole‐body measurement of tumor activity by fluorine‐18 fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) in hormone‐refractory prostate cancer (HRPC). Methods: Serial FCH PET/CT scans were performed in eight patients with HRPC receiving docetaxel‐based chemotherapy. Corresponding serial cfDNA samples were characterized by microfluidic electrophoresis, quantified by real‐time PCR, and compared with PET/CT results. Promoter methylation of two prostate cancer‐associated genes, GSTP1 and RARB2, was assessed by methylation‐specific PCR of bisulfite‐converted cfDNA. Results: Plasma cfDNA concentrations increased significantly from 13.3 ng/mL at baseline to 46.8 ng/mL and 50.9 ng/mL after one and three treatment cycles, respectively (p= 0.001). GSTP1 and/or RARB2 promoter methylation was identified in all pretreatment samples. The appearance of large (200 bp–10.4 kb) cfDNA fragments was noted in posttreatment samples along with loss of methylation at GSTP1 and/or RARB2. Tumor activity on PET/CT correlated with cfDNA concentration (r=−0.50, p= 0.01). Patients meeting criteria for PET tumor response had significantly lower pretreatment cfDNA levels than those who did not (8.0 vs. 16.4 ng/mL, p= 0.03). Conclusions: Chemotherapy is associated with significant changes in plasma cfDNA content and FCH PET/CT‐detected tumor activity. These interrelated measures are potential candidate markers of therapeutic response in HRPC. Clin Trans Sci 2012; Volume #: 1–6
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Affiliation(s)
- Sandi Kwee
- The University of Hawaii Cancer Center, Honolulu, HI, USA.
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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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18F-fluorocholine for prostate cancer imaging: a systematic review of the literature. Prostate Cancer Prostatic Dis 2011; 15:45-55. [DOI: 10.1038/pcan.2011.35] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Positron emission tomography (PET) is a noninvasive imaging technique that provides a functional or metabolic assessment of normal tissue or disease conditions. Fluorine 18-fluorodeoxyglucose PET imaging (FDG-PET) is widely used clinically for tumor imaging due to increased glucose metabolism in most types of tumors, and has been shown to improve the diagnosis and subsequent treatment of cancers. We review its use in cancer diagnosis, staging, restaging, and assessment of response to treatment. In addition, other metabolic PET imaging agents in pre-clinical research or clinical trial stages of development are discussed, including amino acid analogs based on increased protein synthesis, and choline, which is based on increased membrane lipid synthesis. Amino acid analogs and choline are more specific to tumor cells than FDG, so they play an important role in differentiating cancers from benign conditions and in the diagnosis of cancers with low FDG uptake or high background FDG uptake. For decades, researchers have shown that tumors display altered metabolic profiles with elevated uptake of glucose, amino acids, and lipids. This can be used for cancer diagnosis and monitoring of the therapeutic response with excellent signal-to-noise ratios.
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Affiliation(s)
- Aizhi Zhu
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
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Current molecular imaging positron emitting radiotracers in oncology. Nucl Med Mol Imaging 2011; 45:1-14. [PMID: 24899972 DOI: 10.1007/s13139-011-0075-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 01/21/2011] [Indexed: 12/21/2022] Open
Abstract
Molecular imaging is one of the fastest growing areas of medical imaging. Positron emission tomography (PET) has been widely used in the clinical management of patients with cancer. Nuclear imaging provides biological information at the cellular, subcellular, and molecular level in living subjects with non-invasive procedures. In particular, PET imaging takes advantage of traditional diagnostic imaging techniques and introduces positron-emitting probes to determine the expression of indicative molecular targets at different stages of cancer. (18)F-fluorodeoxyglucose ((18)F-FDG), the only FDA approved oncological PET tracer, has been widely utilized in cancer diagnosis, staging, restaging, and even monitoring response to therapy; however, (18)F-FDG is not a tumor-specific PET tracer. Over the last decade, many promising tumor-specific PET tracers have been developed and evaluated in preclinical and clinical studies. This review provides an overview of the current non-(18)F-FDG PET tracers in oncology that have been developed based on tumor characteristics such as increased metabolism, hyperproliferation, angiogenesis, hypoxia, apoptosis, and tumor-specific antigens and surface receptors.
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Daniels S, Tohid SFM, Velanguparackel W, Westwell AD. The role and future potential of fluorinated biomarkers in positron emission tomography. Expert Opin Drug Discov 2010; 5:291-304. [DOI: 10.1517/17460441003652967] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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