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Evangelista L, Zattoni F, Burei M, Bertin D, Borsatti E, Baresic T, Farsad M, Trenti E, Bartolomei M, Panareo S, Urso L, Trifirò G, Brugola E, Chierichetti F, Donner D, Setti L, Gallan M, Del Bianco P, Magni G, De Salvo GL, Novara G. A Prospective Randomized Multicenter Study on the Impact of [ 18F]F-Choline PET/CT Versus Conventional Imaging for Staging Intermediate- to High-Risk Prostate Cancer. J Nucl Med 2024; 65:1013-1020. [PMID: 38844361 DOI: 10.2967/jnumed.123.267355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/07/2024] [Indexed: 07/03/2024] Open
Abstract
This study aimed to compare the efficacy of [18F]F-choline PET/CT with conventional imaging for staging and managing intermediate- to high-risk prostate cancer (PCa). The primary objective was to assess the ability of PET/CT with [18F]F-choline to identify lymph node and systemic involvement during initial staging. Secondary objectives included evaluating the impact of [18F]F-choline PET/CT on unnecessary local treatments and assessing the safety of [18F]F-choline agents. Additionally, the study aimed to analyze recurrence-free survival and overall survival 5 y after randomization. Methods: A prospective controlled, open, randomized multicenter phase III trial involving 7 Italian centers was conducted. Eligible patients with intermediate- to high-risk PCa were randomized in a 1:1 ratio. Two groups were formed: one undergoing conventional imaging (abdominopelvic contrast-enhanced CT and bone scanning) and the other receiving conventional imaging plus [18F]F-choline PET/CT. The study was terminated prematurely; however, all the endpoints were thoroughly analyzed and enriched. Results: Between February 2016 and December 2020, 256 patients were randomly assigned. In total, 236 patients (117 in the control arm and 119 in the experimental arm) were considered for the final assessment. In the experimental arm, the sensitivity for lymph node metastases, determined by final pathology and serial prostate-specific antigen evaluations, was higher than in the control arm (77.78% vs. 28.57% and 65.62% vs. 17.65%, respectively). The [18F]F-choline was tolerated well. The use of [18F]F-choline PET/CT resulted in an approximately 8% reduction in unnecessary extended lymphadenectomy compared with contrast-enhanced CT. Additionally, [18F]F-choline PET/CT had a marginal impact on 5-y overall survival, contributing to a 4% increase in survival rates. Conclusion: In the initial staging of PCa, [18F]F-choline PET/CT exhibited diagnostic performance superior to that of conventional imaging for detecting metastases. [18F]F-choline PET/CT reduced the rate of unnecessary extensive lymphadenectomy by up to 8%. These findings support the consideration of discontinuing conventional imaging for staging PCa.
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Affiliation(s)
- Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy;
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Fabio Zattoni
- Urology Unit, Department of Surgery, Oncology, and Gastroenterology, Urologic Unit, University of Padua, Padua, Italy
- Department of Medicine, DIMED, University of Padua, Padua, Italy
| | - Marta Burei
- Nuclear Medicine Unit, Veneto Institute of Oncology, Padua, Italy
| | - Daniele Bertin
- Nuclear Medicine Unit, Veneto Institute of Oncology, Padua, Italy
| | - Eugenio Borsatti
- Nuclear Medicine Unit, Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Tanja Baresic
- Nuclear Medicine Unit, Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Mohsen Farsad
- Department of Nuclear Medicine, Central Hospital of Bolzano, Bozen, Italy
| | - Emanuela Trenti
- Department of Urology, Central Hospital of Bolzano, Bozen, Italy
| | | | - Stefano Panareo
- Nuclear Medicine Unit, University Hospital, Ferrara, Italy
- Nuclear Medicine Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Luca Urso
- Nuclear Medicine Unit, University Hospital, Ferrara, Italy
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | | | | | - Franca Chierichetti
- Nuclear Medicine Unit, APSS della Provincia Autonoma di Trento, Santa Chiara Hospital, Trento, Italy
| | - Davide Donner
- Nuclear Medicine Unit, APSS della Provincia Autonoma di Trento, Santa Chiara Hospital, Trento, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Lucia Setti
- Nuclear Medicine Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - Mauro Gallan
- Nuclear Medicine Unit, Dell'Angelo Hospital, Mestre-Venezia, Italy; and
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology, Padua, Italy
| | - Giovanna Magni
- Clinical Research Unit, Veneto Institute of Oncology, Padua, Italy
| | | | - Giacomo Novara
- Urology Unit, Department of Surgery, Oncology, and Gastroenterology, Urologic Unit, University of Padua, Padua, Italy
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Cardona Arboniés J, Rodríguez Alfonso B, Mucientes Rasilla J, Martínez Ballesteros C, Zapata Paz I, Prieto Soriano A, Carballido Rodriguez J, Mitjavila Casanovas M. 18 F-Choline PET/CT scan in staging and biochemical recurrence in prostate cancer patients: Changes in classification and radiotherapy planning. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cardona Arboniés J, Rodríguez Alfonso B, Mucientes Rasilla J, Martínez Ballesteros C, Zapata Paz I, Prieto Soriano A, Carballido Rodriguez J, Mitjavila Casanovas M. 18F-Choline PET/CT scan in staging and biochemical recurrence in prostate cancer patients: Changes in classification and radiotherapy planning. Rev Esp Med Nucl Imagen Mol 2017; 36:292-297. [PMID: 28366421 DOI: 10.1016/j.remn.2017.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the role of the 18F-Choline PET/CT in prostate cancer management when detecting distant disease in planning radiotherapy and staging and to evaluate the therapy changes guided by PET/TC results. MATERIAL AND METHODS A retrospective evaluation was performed on 18F-Choline PET/CT scans of patients with prostate cancer. Staging and planning radiotherapy scans were selected in patients with at least 9 months follow up. There was a total of 56 studies, 33 (58.93%) for staging, and 23 (41.07%) for planning radiotherapy. All scans were obtained using a hybrid PET/CT scanner. The PET/CT acquisition protocol consisted of a dual-phase procedure after the administration of an intravenous injection of 296-370MBq of 18F-Choline. RESULTS There were 43 out of 56 (76.8%) scans considered as positive, and 13 (23.2%) were negative. The TNM staging was changed in 13 (23.2%) scans. The PET/CT findings ruled out distant disease in 4 out of 13 scans, and unknown distant disease was detected in 9 (69.3%) scans. CONCLUSIONS 18F-Choline PET/CT is a useful technique for detecting unknown distant disease in prostate cancer when staging and planning radiotherapy. The inclusion of 18F-choline PET/CT should be considered in prostate cancer management protocols.
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Affiliation(s)
- J Cardona Arboniés
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, España.
| | - B Rodríguez Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, España
| | - J Mucientes Rasilla
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, España
| | | | - I Zapata Paz
- Servicio de Oncología Radioterápica, Hospital Universitario Puerta de Hierro, Majadahonda, España
| | - A Prieto Soriano
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, España
| | | | - M Mitjavila Casanovas
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, España
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de Perrot T, Rager O, Scheffler M, Lord M, Pusztaszeri M, Iselin C, Ratib O, Vallee JP. Potential of hybrid ¹⁸F-fluorocholine PET/MRI for prostate cancer imaging. Eur J Nucl Med Mol Imaging 2014; 41:1744-55. [PMID: 24841413 DOI: 10.1007/s00259-014-2786-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/15/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To report the first results of hybrid (18)F-fluorocholine PET/MRI imaging for the detection of prostate cancer. METHODS This analysis included 26 consecutive patients scheduled for prostate PET/MRI before radical prostatectomy. The examinations were performed on a hybrid whole-body PET/MRI scanner. The MR acquisitions which included T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences were followed during the same session by whole-body PET scans. Parametric maps were constructed to measure normalized T2-weighted intensity (nT2), apparent diffusion coefficient (ADC), volume transfer constant (K (trans)), extravascular extracellular volume fraction (v e) and standardized uptake values (SUV). With pathology as the gold standard, ROC curves were calculated using logistic regression for each parameter and for the best combination with and without PET to obtain a MR model versus a PETMR model. RESULTS Of the 26 patients initially selected, 3 were excluded due to absence of an endorectal coil (2 patients) or prosthesis artefacts (1 patient). In the whole prostate, the area under the curve (AUC) for SUVmax, ADC, nT2, K (trans) and v e were 0.762, 0.756, 0.685, 0.611 and 0.529 with a best threshold at 3.044 for SUVmax and 1.075 × 10(-3) mm(2)/s for ADC. The anatomical distinction between the transition zone and the peripheral zone showed the potential of the adjunctive use of PET. In the peripheral zone, the AUC of 0.893 for the PETMR model was significantly greater (p = 0.0402) than the AUC of 0.84 for the MR model only. In the whole prostate, no relevant correlation was observed between ADC and SUVmax. The SUVmax was not affected by the Gleason score. CONCLUSION The performance of a hybrid whole-body (18)F-fluorocholine PET/MRI scan in the same session combined with a prostatic MR examination did not interfere with the diagnostic accuracy of the MR sequences. The registration of the PET data and the T2 anatomical MR sequence data allowed precise localization of hypermetabolic foci in the prostate. While in the transition zone the adenomatous hyperplasia interfered with cancer detection by PET, the quantitative analysis tool performed well for cancer detection in the peripheral zone.
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Affiliation(s)
- Thomas de Perrot
- Division of Radiology, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland,
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Vees H, Steiner C, Dipasquale G, Chouiter A, Zilli T, Velazquez M, Namy S, Ratib O, Buchegger F, Miralbell R. Target volume definition in high-risk prostate cancer patients using sentinel node SPECT/CT and 18 F-choline PET/CT. Radiat Oncol 2012; 7:134. [PMID: 22873771 PMCID: PMC3561224 DOI: 10.1186/1748-717x-7-134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/17/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To assess the influence of sentinel lymph nodes (SNs) SPECT/CT and 18 F-choline (18 F-FCH) PET/CT in radiotherapy (RT) treatment planning for prostate cancer patients with a high-risk for lymph node (LN) involvement. METHODS Twenty high-risk prostate cancer patients underwent a pelvic SPECT acquisition following a transrectal ultrasound guided injection of 99mTc-Nanocoll into the prostate. In all patients but one an 18 F-FCH PET/CT for RT treatment planning was performed. SPECT studies were coregistered with the respective abdominal CTs. Pelvic SNs localized on SPECT/CT and LN metastases detected by 18 F-FCH PET/CT were compared to standard pelvic clinical target volumes (CTV). RESULTS A total of 104 pelvic SNs were identified on SPECT/CT (mean 5.2 SNs/patient; range 1-10). Twenty-seven SNs were located outside the standard pelvic CTV, 17 in the proximal common iliac and retroperitoneal regions above S1, 9 in the pararectal fat and 1 in the inguinal region. SPECT/CT succeeded to optimize the definition of the CTV and treatment plans in 6/20 patients due to the presence of pararectal SNs located outside the standard treatment volume. 18 F-FCH PET/CT identified abnormal tracer uptake in the iliac LN region in 2/19 patients. These abnormal LNs were negative on SPECT/CT suggesting a potential blockade of lymphatic drainage by metastatic LNs with a high tumour burden. CONCLUSIONS Multimodality imaging which combines SPECT/CT prostate lymphoscintigraphy and 18 F-FCH PET/CT identified SNs outside standard pelvic CTVs or highly suspicious pelvic LNs in 40% of high-risk prostate cancer patients, highlighting the potential impact of this approach in RT treatment planning.
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Affiliation(s)
- Hansjörg Vees
- Division of Radiation Oncology, University Hospital, Geneva, Switzerland.
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Evans-Axelsson S, Ulmert D, Örbom A, Peterson P, Nilsson O, Wennerberg J, Strand J, Wingårdh K, Olsson T, Hagman Z, Tolmachev V, Bjartell A, Lilja H, Strand SE. Targeting free prostate-specific antigen for in vivo imaging of prostate cancer using a monoclonal antibody specific for unique epitopes accessible on free prostate-specific antigen alone. Cancer Biother Radiopharm 2012; 27:243-51. [PMID: 22489659 DOI: 10.1089/cbr.2011.1088] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study investigated the feasibility of targeting the free, unbound forms of prostate-specific antigen (fPSA) for in vivo imaging of prostate adenocarcinomas (PCa), as PSA is produced and secreted at abundance during every clinical stage and grade of PCa, including castration-resistant disease. We injected (125)I-labeled monoclonal antibody PSA30 (specific for an epitope uniquely accessible on fPSA alone) intravenously in male nude mice carrying subcutaneous xenografts of LNCaP tumors (n=36). Mice were sacrificed over a time course from 4 hours to 13 days after injecting (125)I-labeled PSA30. Tissue uptake of (125)I-PSA30 at 48 and 168 hours after intravenous injection was compared with two clinically used positron emission tomography radiopharmaceuticals, (18)F-fluoro-deoxy-glucose ((18)F-FDG) or (18)F-choline, in cryosections using Digital AutoRadiography (DAR) and also compared with immunohistochemical staining of PSA and histopathology. On DAR, the areas with high (125)I-PSA30 uptake corresponded mainly to morphologically intact and PSA-producing LNCaP cells, but did not associate with the areas of high uptake of either (18)F-FDG or (18)F-choline. Biodistribution of (125)I-PSA30 measured in dissected organs ex vivo during 4 to 312 hours after intravenous injection demonstrated maximum selective tumor uptake 24-48 hours after antibody injection. Our data showed selective uptake in vivo of a monoclonal antibody highly specific for fPSA in LNCaP cells. Hence, in vivo imaging of fPSA may be feasible with putative usefulness in disseminated PCa.
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Affiliation(s)
- Susan Evans-Axelsson
- Division of Urological Cancers, Department of Clinical Sciences, Lund University, Malmö, Sweden.
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Gao M, Wang M, Miller KD, Zheng QH. Facile radiosynthesis of new carbon-11-labeled propanamide derivatives as selective androgen receptor modulator (SARM) radioligands for prostate cancer imaging. Steroids 2011; 76:1505-12. [PMID: 21867721 DOI: 10.1016/j.steroids.2011.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 08/08/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
Abstract
The androgen receptor (AR) is an attractive target for the treatment and molecular imaging of prostate cancer. New carbon-11-labeled propanamide derivatives were first designed and synthesized as selective androgen receptor modulator (SARM) radioligands for prostate cancer imaging using the biomedical imaging technique positron emission tomography (PET). The target tracers, (S)-N-(4-cyano-3-(trifluoromethyl)phenyl)-2-hydroxy-3-(2-[(11)C]methoxyphenoxy)-2-methylpropanamide ([(11)C]8a), (S)-2-hydroxy-3-(2-[(11)C]methoxyphenoxy)-2-methyl-N-(4-nitro-3-(trifluoromethyl)phenyl)propanamide ([(11)C]8 e), (S)-N-(4-cyano-3-(trifluoromethyl)phenyl)-2-hydroxy-3-(4-[(11)C]methoxyphenoxy)-2-methylpropanamide ([(11)C]8c) and (S)-2-hydroxy-3-(4-[(11)C]methoxyphenoxy)-2-methyl-N-(4-nitro-3-(trifluoromethyl)phenyl)propanamide ([(11)C]8 g), were prepared by O-[(11)C]methylation of their corresponding precursors, (S)-N-(4-cyano-3-(trifluoromethyl)phenyl)-2-hydroxy-3-(2-hydroxyphenoxy)-2-methylpropanamide (9a), (S)-2-hydroxy-3-(2-hydroxyphenoxy)-2-methyl-N-(4-nitro-3-(trifluoromethyl)phenyl)propanamide (9b), (S)-N-(4-cyano-3-(trifluoromethyl)phenyl)-2-hydroxy-3-(4-hydroxyphenoxy)-2-methylpropanamide (9 c) and (S)-2-hydroxy-3-(4-hydroxyphenoxy)-2-methyl-N-(4-nitro-3-(trifluoromethyl)phenyl)propanamide (9 d), with [(11)C]CH(3)OTf under basic conditions and isolated by a simplified C-18 solid-phase extraction (SPE) method in 55 ± 5% (n = 5) radiochemical yields based on [(11)C]CO(2) and decay corrected to end of bombardment (EOB). The overall synthesis time from EOB was 23 min, the radiochemical purity was >99%, and the specific activity at end of synthesis (EOS) was 277.5 ± 92.5 GBq/μmol (n = 5).
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Affiliation(s)
- Mingzhang Gao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 1345 West 16th Street, L3-202, Indianapolis, IN 46202-2111, USA
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Abstract
A 57-year-old man with an adenocarcinoma of the prostate, presented with multiple lymph nodes in the para-aortic and right iliac region on computer tomography (CT). However, since the radiologic images were taken 3 weeks following an urosepsis, the differentiation between inflamed and metastatic lymph nodes is difficult. Thus, an integrated [C] choline positron emission tomography and computer tomography (PET/CT) was performed, showing multiple lymph nodes. The patient was staged as cT3N1M0 and treated with hormonal therapy. The choline PET/CT performed after hormonal treatment showed no more hypermetabolic lymph nodes. This case substantiate the hypothesis that choline PET/CT could be used to evaluate therapy response in prostate cancer patients.
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Role of carbon-11 choline PET/CT in the management of uterine carcinoma: initial experience. Ann Nucl Med 2009; 23:235-43. [DOI: 10.1007/s12149-009-0230-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 11/27/2008] [Indexed: 12/01/2022]
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Bone imaging in prostate cancer. ACTA ACUST UNITED AC 2009; 5:434-44. [PMID: 18682719 DOI: 10.1038/ncpuro1190] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 06/30/2008] [Indexed: 01/25/2023]
Abstract
Bone metastases of solid tumors are common, and about 80% of them occur in patients with breast, lung or prostate cancer. Bone metastases can be suspected clinically and by laboratory tests; however, a final diagnosis relies on radiographic evidence. Bone metastases of prostate cancer usually have osteoblastic characteristics, manifested by pathological bone resorption and formation. Conventional bone scans (e.g. with (99m)Tc-labeled methylene diphosphonate) are preferred to plain-film radiography for surveillance of the entire skeleton. Radiologic diagnosis of bone metastases, particularly in patients with low burden of disease, is difficult because noncancerous bone lesions that mimic cancer are common. Conventional bone scans are limited by their low sensitivity and high false-negative rate (up to 40%) compared with advanced bone-imaging modalities such as PET, PET-CT and MRI, which might assist or replace conventional scanning methods. The correct diagnosis of bone involvement in prostate cancer is crucial to assess the effects of therapy on the primary tumor, the patient's prognosis, and the efficacy of bone-specific treatments that can reduce future bone-associated morbidity. In addition, predictive tools such as nomograms enable the identification of patients at risk of bone involvement during the course of their disease. Such tools may limit treatment costs by avoidance of unnecessary tests and might reduce both short-term and long-term complication rates.
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Talbot JN, Gutman F, Huchet V, Kerrou K, Balogova S, Kerrouche N, Montravers F, Grahek D, Cussenot O, Gattegno B, Thibault P. Utilité clinique de la tomographie par émission de positons dans le cancer de la prostate. Presse Med 2007; 36:1794-806. [PMID: 17524607 DOI: 10.1016/j.lpm.2007.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 02/08/2007] [Indexed: 11/29/2022] Open
Abstract
In prostate cancer, use of FDG, the radiopharmaceutical currently most widely used in oncology, is limited to the most aggressive cancers and, in the absence of another tracer, to attempting to localise occult recurrences detected biochemically (elevated PSA serum levels). Four other PET tracers are currently suggested in various situations of prostate cancer development: for guiding biopsies, for diagnosis and staging of the primary cancer and of local or metastatic recurrences, especially in bone, and for localizing occult biochemical recurrence. This article is illustrated by cases summarising our experience with fluoromethylcholine-(18F) and PET/CT. They cover a wide spectrum of clinical settings: localisation of intraprostatic neoplastic lesions, initial staging, monitoring treatment by ultrasound, detection of occult recurrences and characterisation of images on conventional imaging modalities, which are questionable or difficult to interpret.
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Affiliation(s)
- Jean-Noël Talbot
- Service de médecine nucléaire, Hôpital Tenon, Université Pierre et Marie Curie, Paris.
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Abstract
PURPOSE OF REVIEW Appropriate imaging of prostate cancer is a crucial component of staging and therapy application. The purpose of this review is to highlight the most important developments in novel imaging modalities reported in the past year. RECENT FINDINGS Transrectal ultrasound is used to guide needle biopsy and brachytherapy. Improved results are obtained with color and power Doppler transrectal ultrasound with sonographic contrast agents. The role of elastography in prostate cancer remains to be elucidated. Magnetic resonance imaging is now widely used for staging before treatment and accumulating data indicate the utility of this technique with magnetic resonance spectroscopy in staging and follow-up. Positron-emission tomography alone or especially in combination with computed tomography imaging with the new radiotracers (11)C-choline, (18)F-fluorocholine, (11)C-acetate and (18)F-fluoride have shown promising results. Further investigations in larger clinical studies are necessary to establish the role of these imaging techniques in the management of patients with prostate cancer. SUMMARY This report provides a summary of novel types of imaging and indicates their promise in prostate cancer.
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Affiliation(s)
- Peter Oehr
- Department of Nuclear Medicine, University of Bonn, Bonn, Germany
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