MRI in the Management of Prostate Cancer

A Rare Case of Neuroendocrine Prostate Cancer Detected on 68Ga - DOTANOC Positron Emission Tomography/Computed Tomography (PET/CT)

Prostate cancer is one of the most common malignancies affecting elderly men worldwide and the fifth leading cause of cancer death in men. Prostate cancer includes many histological variants with the prostatic acinar adenocarcinoma variant accounting for the majority of the diagnosed cases. Other less common histological variants are broadly classified as non-acinar carcinomas. One of the non-acinar carcinoma variants is neuroendocrine prostate cancer (NEPC). NEPC can emerge as a mechanism of treatment resistance in castration-resistant conventional prostate cancer and can also rarely be seen as a primary histological form at the time of initial diagnosis. Like other non-acinar carcinoma variants of prostate cancer, NEPC is also an aggressive variant with associated poor prognosis. Neuroendocrine tumors (NETs) are characterized by the expression of somatostatin receptors (SSTRs). Positron emission tomography/computed tomography (PET/CT) using radiolabeled somatostatin analogs like DOTANOC have been used to detect and stage these NETs. These radiolabeled somatostatin analogs also provide the option of treatment of these tumors and have been used in peptide receptor radionuclide therapy of these tumors. NEPC being a neuroendocrine malignancy also expresses SSTRs and hence can be detected with PET/CT radiotracers like 68Gallium-labeled somatostatin analogs. We here report a case of metastatic treatment-emergent NEPC detected on 68Ga - DOTANOC PET/CT.

Literature review: Imaging in prostate cancer

Imaging plays an increasingly important role in the detection and characterization of prostate cancer (PC). This review summarizes the key conventional and advanced imaging modalities including multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging and tries to instruct clinicians in finding the best image modality depending on the patient`s PC-stage. We aim to give an overview of the different image modalities and their benefits and weaknesses in imaging PC. Emphasis is put on primary prostate cancer detection and staging as well as on recurrent and castration resistant prostate cancer. Results from studies using various imaging techniques are discussed and compared. For the different stages of PC, advantages and disadvantages of the different imaging modalities are discussed. Moreover, this review aims to give an outlook about upcoming, new imaging modalities and how they might be implemented in the future into clinical routine. Imaging patients suffering from PC should aim for exact diagnosis, accurate detection of PC lesions and should mirror the true tumor burden. Imaging should lead to the best patient treatment available in the current PC-stage and should avoid unnecessary therapeutic interventions. New image modalities such as long axial field of view PET/CT with photon-counting CT and radiopharmaceuticals like androgen receptor targeting radiopharmaceuticals open up new possibilities. In conclusion, PC imaging is growing and each image modality is aiming for improvement.