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Crișan G, Moldovean-Cioroianu NS, Timaru DG, Andrieș G, Căinap C, Chiș V. Radiopharmaceuticals for PET and SPECT Imaging: A Literature Review over the Last Decade. Int J Mol Sci 2022; 23:5023. [PMID: 35563414 PMCID: PMC9103893 DOI: 10.3390/ijms23095023] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
Positron emission tomography (PET) uses radioactive tracers and enables the functional imaging of several metabolic processes, blood flow measurements, regional chemical composition, and/or chemical absorption. Depending on the targeted processes within the living organism, different tracers are used for various medical conditions, such as cancer, particular brain pathologies, cardiac events, and bone lesions, where the most commonly used tracers are radiolabeled with 18F (e.g., [18F]-FDG and NA [18F]). Oxygen-15 isotope is mostly involved in blood flow measurements, whereas a wide array of 11C-based compounds have also been developed for neuronal disorders according to the affected neuroreceptors, prostate cancer, and lung carcinomas. In contrast, the single-photon emission computed tomography (SPECT) technique uses gamma-emitting radioisotopes and can be used to diagnose strokes, seizures, bone illnesses, and infections by gauging the blood flow and radio distribution within tissues and organs. The radioisotopes typically used in SPECT imaging are iodine-123, technetium-99m, xenon-133, thallium-201, and indium-111. This systematic review article aims to clarify and disseminate the available scientific literature focused on PET/SPECT radiotracers and to provide an overview of the conducted research within the past decade, with an additional focus on the novel radiopharmaceuticals developed for medical imaging.
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Affiliation(s)
- George Crișan
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
- Department of Nuclear Medicine, County Clinical Hospital, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | | | - Diana-Gabriela Timaru
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
| | - Gabriel Andrieș
- Department of Nuclear Medicine, County Clinical Hospital, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Călin Căinap
- The Oncology Institute “Prof. Dr. Ion Chiricuţă”, Republicii 34-36, 400015 Cluj-Napoca, Romania;
| | - Vasile Chiș
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
- Institute for Research, Development and Innovation in Applied Natural Sciences, Babeș-Bolyai University, Str. Fântânele 30, 400327 Cluj-Napoca, Romania
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Puterman C, Bjöersdorff M, Amidi J, Anand A, Soller W, Jiborn T, Kjölhede H, Trägårdh E, Bjartell A. A retrospective study assessing the accuracy of [18F]-fluorocholine PET/CT for primary staging of lymph node metastases in intermediate and high-risk prostate cancer patients undergoing robotic-assisted laparoscopic prostatectomy with extended lymph node dissection. Scand J Urol 2021; 55:293-297. [PMID: 33939583 DOI: 10.1080/21681805.2021.1914720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have investigated [18F]-fluorocholine (FCH) positron emission tomography with computed tomography (PET/CT) in primary staging of men with intermediate or high-risk prostate cancer and have generally shown high specificity and poor sensitivity. FCH PET/CT is not recommended for the primary staging of metastases in the European guidelines for prostate cancer. However, it has been an option in the Swedish recommendations. Our aim was to assess PET/CT for primary staging of lymph node metastases before robotic-assisted laparoscopic prostatectomy (RALP) with extended pelvic lymph node dissection (ePLND) in patients with intermediate or high-risk prostate cancer. METHOD We identified all men with prostate cancer undergoing FCH PET/CT for initial staging followed by RALP and ePLND at Skåne University Hospital between 2015 and 2018. The result from PET/CT scan was compared with pathology report as the reference method for calculation of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS In total, 252 patients were included in the final analysis. Among 85 patients with a suspicion of regional lymph node metastases on FCH PET/CT only 31 had pathology-proven metastases. The sensitivity was 43% (95% CI 0.32-0.55) and the specificity 70% (95% CI 0.63-0.76) for PET/CT to predict lymph node metastases. PPV was 36% and NPV was 75%. Risk group analyses showed similar results. CONCLUSION Our study emphasizes the poor performance of FCH PET/CT to predict lymph node metastasis in intermediate and high-risk prostate cancer. The method should be replaced with newer radiopharmaceuticals, such as prostate-specific membrane antigen ligands.
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Affiliation(s)
| | - Mimmi Bjöersdorff
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Malmö, Sweden
| | - Jennifer Amidi
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Aseem Anand
- Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Wolfgang Soller
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Thomas Jiborn
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Henrik Kjölhede
- Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden.,Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Elin Trägårdh
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Malmö, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
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Salvage Pelvic Lymph Node Dissection and Current State of Imaging for Recurrent Prostate Cancer: Does a Standard Exist? Curr Urol Rep 2020; 21:62. [PMID: 33159608 DOI: 10.1007/s11934-020-01011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW We aim to evaluate the efficacy of salvage lymph node dissection (SLND) for nodal recurrent prostate cancer after primary treatment. We also provide a review of the diagnostic performance of next-generation sequencing (next-generation imaging (NGI)) radiotracers in the salvage setting. RECENT FINDINGS Most studies evaluating SLND include a heterogeneous population with a small sample size and are retrospective in design. The 5-year clinical recurrence-free and cancer-specific survival following SLND are 26-52% and 57-89%, respectively, among prospective studies. NGI improves accuracy in detecting nodal recurrence compared to conventional CT, with PMSA PET-CT showing the most promise. However, limited studies exist comparing imaging modalities and performance is variable at low PSA values. SLND is a promising treatment option, but more prospective data are needed to determine the ideal surgical candidate and long-term oncologic outcomes. More studies comparing different NGI are needed to determine the best imaging modality in patients who may be candidates for salvage treatment.
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Hatano K, Tanaka J, Nakai Y, Nakayama M, Kakimoto KI, Nakanishi K, Nishimura K. Utility of index lesion volume assessed by multiparametric MRI combined with Gleason grade for assessment of lymph node involvement in patients with high-risk prostate cancer. Jpn J Clin Oncol 2020; 50:333-337. [PMID: 31829421 DOI: 10.1093/jjco/hyz170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/03/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We examined the potential predictors of lymph node involvement and evaluated whether index lesion volume assessed using multiparametric magnetic resonance imaging is associated with lymph node involvement among patients with high-risk prostate cancer. METHODS Extended pelvic lymph node dissection was used to evaluate patients with lymph node involvement. We retrospectively analyzed consecutive 102 patients with high-risk prostate cancer who underwent extended pelvic lymph node dissection at our institution between 2011 and 2017. To evaluate the index lesion volume at multiparametric magnetic resonance imaging (mrV), lesions were manually contoured on each T2-weighted axial slice in combination with diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging and integrated using image analysis software. Logistic regression analysis was performed to identify predictors of lymph node involvement. RESULTS The median mrV was 1.4 ml (range 0-30.1 ml), and the median number of resected lymph nodes was 14 (range 7-38). Among 102 patients, 28 (28%) had lymph node involvement. Multivariate analysis identified significant predictors of lymph node involvement as follows: biopsy Gleason-grade group 5 (odds ratio = 17.2; 95% confidence interval, 2.1-299.0; P = 0.005), preoperative mrV (odds ratio = 1.14; 95% confidence interval, 1.02-1.30; P = 0.025) and percentage of positive cores with highest Gleason-grade group (odds ratio = 1.05; 95% confidence interval, 1.01-1.10; P = 0.005). Lymph node involvement was prevalent (69%) among tumors with Gleason-grade group 5 and mrV ≥3.4 ml, but was infrequently (10%) present among tumors with Gleason-grade group ≤4 and mrV <3.4 ml. CONCLUSIONS The combination of biopsy Gleason-grade and mrV may serve as a useful tool to stratify patients according to their risk of nodal metastases.
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Affiliation(s)
- Koji Hatano
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Junichiro Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Ken-Ichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Katsuyuki Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
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Comparison of 68Ga-PSMA-11 PET/CT with 11C-acetate PET/CT in re-staging of prostate cancer relapse. Sci Rep 2020; 10:4993. [PMID: 32193430 PMCID: PMC7081247 DOI: 10.1038/s41598-020-61910-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/04/2020] [Indexed: 12/24/2022] Open
Abstract
Positron emission tomography (PET) imaging is used to localize recurrent disease in prostate cancer (PCa). The tracer 68Ga-PSMA-11 visualizes lesions overexpressing prostate-specific membrane antigen (PSMA), while 11C-acetate visualizes lesions with increased anabolic metabolism. The aim of this study was to compare the performance of PSMA-PET and acetate-PET in re-staging patients with biochemical relapse. Thirty PCa patients with prostate-specific antigen (PSA) relapse after primary curative therapy were prospectively evaluated. PET/CT examinations using 11C-acetate and 68Ga-PSMA-11 were performed. Identified lesions were categorized according to anatomical location and PET measurements were correlated with PSA at time of scan. Tumour lesions showed higher semi-quantitative uptake values on PSMA-PET than acetate-PET. PSMA-PET identified more lesions in 11 patients, fewer lesions in eight patients, and identical number of lesions in 11 patients. This study indicates better diagnostic performance of PSMA-PET, particularly in detecting lymph node (81% vs 60%, p = 0.02) and bone metastasis (95% vs 61%, p = 0.0001) compared to acetate-PET. However, 38% of PSMA-expressing metastases appear to be metabolically inactive and 15% of metabolically active metastases lack PSMA expression. Addition of PET with a metabolic tracer, such as 11C-acetate, might be beneficial before making treatment decisions.
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Regula N, Honarvar H, Lubberink M, Jorulf H, Ladjevardi S, Häggman M, Antoni G, Buijs J, Velikyan I, Sörensen J. Carbon Flux as a Measure of Prostate Cancer Aggressiveness: [ 11C]-Acetate PET/CT. Int J Med Sci 2020; 17:214-223. [PMID: 32038105 PMCID: PMC6990881 DOI: 10.7150/ijms.39542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/12/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose: Dynamic [11C]-acetate positron emission tomography (PET) can be used to study tissue perfusion and carbon flux simultaneously. In this study, the feasibility of the quantification of prostate cancer aggressiveness using parametric methods assessing [11C]-acetate kinetics was investigated in prostate cancer subjects. The underlying uptake mechanism correlated with [11C]-acetate influx and efflux measured in real-time in vitro in cell culture. Methods: Twenty-one patients with newly diagnosed low-to-moderate risk prostate cancer underwent magnetic resonance imaging (MRI) and dynamic [11C]-acetate PET/CT examinations of the pelvis. Parametric images of K1 (extraction × perfusion), k2 (oxidative metabolism) and VT (=K1/k2, anabolic metabolism defined as carbon retention) were constructed using a one-tissue compartment model with an arterial input function derived from pelvic arteries. Regions of interest (ROIs) of the largest cancer lesion in each patient and normal prostate tissue were drawn using information from MRI (T2 and DWI images), biopsy results, and post-surgical histopathology of whole prostate sections (n=7). In vitro kinetics of [11C]-acetate were studied on DU145 and PC3 cell lines using LigandTracer® White equipment for the measurement of the radioactivity uptake in real-time at 37°C. Results: Mean prostate specific antigen (PSA) was 8.33±3.92 ng/mL and median Gleason Sum 6 (range 5-7). K1, VT and standardized uptake values (SUVs) were significantly higher in cancerous prostate tissues compared to normal ones for all patients (p<0.001), while k2 was not (p=0.26). PSA values correlated to early SUVs (r=0.50, p=0.02) and K1 (r=0.48, p=0.03). Early and late SUVs correlated to VT (r>0.76, p<0.001) and K1 (r>0.64, p<0.005). In vitro studies demonstrated higher extraction and retention (p<0.01) of [11C]-acetate in the more aggressive PC3 cells. Conclusion: Parametric images could be used to visualize the [11C]-acetate kinetics of the prostate cancer exhibiting elevated extraction associated with the cancer aggressiveness. The influx rate of [11C]-acetate studied in cell culture also showed dependence on the cancer aggressiveness associated with elevated lipogenesis. Dynamic [11C]-acetate/PET demonstrated potential for prostate cancer aggressiveness estimation using parametric-based K1 and VT values.
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Affiliation(s)
- Naresh Regula
- Division of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hadis Honarvar
- Division of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Division of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Jorulf
- Division of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sam Ladjevardi
- Division of Urology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Häggman
- Division of Urology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Antoni
- Division of Molecular Imaging, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jos Buijs
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Irina Velikyan
- Division of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Division of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,PET Centre, Uppsala University Hospital, Uppsala, Sweden
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Gennaro KH, Porter KK, Gordetsky JB, Galgano SJ, Rais-Bahrami S. Imaging as a Personalized Biomarker for Prostate Cancer Risk Stratification. Diagnostics (Basel) 2018; 8:diagnostics8040080. [PMID: 30513602 PMCID: PMC6316045 DOI: 10.3390/diagnostics8040080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023] Open
Abstract
Biomarkers provide objective data to guide clinicians in disease management. Prostate-specific antigen serves as a biomarker for screening of prostate cancer but has come under scrutiny for detection of clinically indolent disease. Multiple imaging techniques demonstrate promising results for diagnosing, staging, and determining definitive management of prostate cancer. One such modality, multiparametric magnetic resonance imaging (mpMRI), detects more clinically significant disease while missing lower volume and clinically insignificant disease. It also provides valuable information regarding tumor characteristics such as location and extraprostatic extension to guide surgical planning. Information from mpMRI may also help patients avoid unnecessary biopsies in the future. It can also be incorporated into targeted biopsies as well as following patients on active surveillance. Other novel techniques have also been developed to detect metastatic disease with advantages over traditional computer tomography and magnetic resonance imaging, which primarily rely on defined size criteria. These new techniques take advantage of underlying biological changes in prostate cancer tissue to identify metastatic disease. The purpose of this review is to present literature on imaging as a personalized biomarker for prostate cancer risk stratification.
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Affiliation(s)
- Kyle H Gennaro
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Das CJ, Razik A, Sharma S. Positron emission tomography in prostate cancer: An update on state of the art. Indian J Urol 2018; 34:172-179. [PMID: 30034126 PMCID: PMC6034413 DOI: 10.4103/iju.iju_320_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Prostate cancer (PCa), one of the most common cancers in males, is a topic of active interest in imaging research. Positron emission tomography/computed tomography (PET/CT) and PET/magnetic resonance imaging (PET/MRI) have enabled the combination of morphologic and functional imaging with the promise of providing better information in guiding therapy. 18F-fluorodeoxyglucose, the workhorse radiopharmaceutical in PET imaging, has not found preference in PCa since these tumors show poor glucose uptake and can be obscured by the normal urinary excretion of the radiotracer. Hence, the last two decades have seen the development of multiple newer radiotracers and better optimization of the technical aspects of PET imaging. The combination of functional imaging and MRI holds great promise. We searched PubMed, Scopus, and Google Scholar for peer-reviewed literature concerning the advances and newer developments in the imaging of PCa between the years 2005 and 2017. This review aims at summarizing current evidence on the role of PET imaging in PCa and its impact on the diagnosis, staging, prognostication, response assessment, and restaging of this malignancy.
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Affiliation(s)
- Chandan Jyoti Das
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Abdul Razik
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
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MRI and 11C Acetate PET/CT for Prediction of Regional Lymph Node Metastasis in Newly Diagnosed Prostate Cancer. Radiol Oncol 2018. [PMID: 29520210 PMCID: PMC5839086 DOI: 10.2478/raon-2018-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background The aim of the study was to examine the value of quantitative and qualitative MRI and 11C acetate PET/CT parameters in predicting regional lymph node (LN) metastasis of newly diagnosed prostate cancer (PCa). Patients and methods Patients with intermediate (n = 6) and high risk (n = 47) PCa underwent 3T MRI (40 patients) and 11C acetate PET/CT (53 patients) before extended pelvic LN dissection. For each patient the visually most suspicious LN was assessed for mean apparent diffusion coefficient (ADCmean), maximal standardized uptake value (SUVmax), size and shape and the primary tumour for T stage on MRI and ADCmean and SUVmax in the index lesion. The variables were analysed in simple and multiple logistic regression analysis. Results All variables, except ADCmean and SUVmax of the primary tumor, were independent predictors of LN metastasis. In multiple logistic regression analysis the best model was ADCmean in combintion with MRI T-stage where both were independent predictors of LN metastasis, this combination had an AUC of 0.81 which was higher than the AUC of 0.65 for LN ADCmean alone and the AUC of 0.69 for MRI T-stage alone. Conclusions Several quantitative and qualitative imaging parameters are predictive of regional LN metastasis in PCa. The combination of ADCmean in lymph nodes and T-stage on MRI was the best model in multiple logistic regression with increased predictive value compared to lymph node ADCmean and T-stage on MRI alone.
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Spick C, Herrmann K, Czernin J. Evaluation of Prostate Cancer with 11C-Acetate PET/CT. J Nucl Med 2017; 57:30S-37S. [PMID: 27694168 DOI: 10.2967/jnumed.115.169599] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/10/2016] [Indexed: 11/16/2022] Open
Abstract
In this article, we will first describe the metabolic fate of 11C-acetate; then discuss its biodistribution in health and disease; and subsequently focus on its key clinical applications, the detection and localization of prostate cancer tissue in patients with primary or recurrent disease. Finally, we will discuss the potential role of 11C-acetate in the context of other prostate cancer imaging probes and non-radionuclide-based imaging approaches.
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Affiliation(s)
- Claudio Spick
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ken Herrmann
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Johannes Czernin
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
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PET imaging for lymph node dissection in prostate cancer. World J Urol 2016; 35:507-515. [PMID: 27752756 DOI: 10.1007/s00345-016-1954-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 10/07/2016] [Indexed: 12/15/2022] Open
Abstract
The detection of neoplastic lymph nodal involvement in prostate cancer (PCa) patients has relevant therapeutic and prognostic significance, both in the clinical settings of primary staging and restaging. Lymph nodal dissection (LND) currently represents the gold standard for evaluating the presence of lymph nodal involvement. However, this procedure is invasive, associated with morbidity, and may fail in detecting all potential lymph nodal metastatic regions. Currently the criteria for lymph nodal detection using conventional imaging techniques mainly rely on morphological assessment with unsatisfactory diagnostic accuracy. Positron emission tomography (PET) represents a helpful imaging technique for a proper staging of lymph nodal status. The most investigated PET radiotracer is choline, although many others have been explored as guide for both primary and salvage LND, such as fluorodeoxyglucose, acetate, fluorocyclobutanecarboxylic acid and prostate-specific membrane antigen. In the present review, a comprehensive literature review addressing the role of PET for LND in PCa patients is reported, with the use of the above-mentioned radiotracers.
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12
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Regula N, Häggman M, Johansson S, Sörensen J. Malignant lipogenesis defined by 11C-acetate PET/CT predicts prostate cancer-specific survival in patients with biochemical relapse after prostatectomy. Eur J Nucl Med Mol Imaging 2016; 43:2131-2138. [PMID: 27392615 DOI: 10.1007/s00259-016-3449-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Malignant de novo lipogenesis is strongly linked to the aggressiveness of prostate cancer (PCa) under experimental conditions. 11C-Acetate PET/CT is a potential noninvasive biomarker of malignant lipogenesis in PCa, but its prognostic value is not known. The objective of this study was to analyse 11C-acetate PET/CT image metrics in relation to survival. METHODS All patients undergoing 11C-acetate PET/CT in one university hospital from 2005 to 2011 due to PSA relapse after previous prostatectomy were retrospectively evaluated. Two groups of patients were compared: those who died from PCa and those who were censored. All previously reported findings of local recurrence, regional or distal lymph node metastases and bone metastases were counted and evaluated regarding 11C-acetate uptake intensity (SUVmax) and tumour volume. Total tumour volume and total lipogenic activity (TLA, summed SUVmax × TV) were calculated. Survival analysis in the entire study population was followed by Cox proportional hazards ratio (HR) analysis. RESULTS A total of 121 patients were included, and 22 PCa-specific deaths were recorded. The mean PSA level at the time of PET was 2.69 ± 4.35 ng/mL. The median follow-up of the study population was 79 ± 28 months. PET identified at least one PCa lesion in 53 % of patients. Five-year PCa-specific survival after PET was 80 % and 100 % in patients with a positive and a negative PET scan, respectively (p < 0.001). Time-to-death was linearly correlated with highest SUVmax (r = -0.55, p = 0.01) and nonlinearly with TLA (r = -0.75, p < 0.001). Multivariate analysis showed statistical significance for number of bone metastases (HR 1.74, p = 0.01), tertile of TLA (HR 5.63, p = 0.029) and postoperative Gleason score (HR 1.84, p = 0.045). CONCLUSION Malignant 11C-acetate accumulation measured with PET/CT is a strong predictor of survival in the setting of PSA relapse after prostatectomy. The study provides further evidence for a quantitative relationship between malignant de novo lipogenesis and early death. 11C-Acetate PET/CT might be useful for identifying a high-risk population of relapsing patients in which therapies targeting malignant lipogenesis might be of particular benefit.
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Affiliation(s)
- Naresh Regula
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Häggman
- Section of Urology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Silvia Johansson
- Section of Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. .,PET Center Research Department, no. 79, 5th floor, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
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