Cancer Treatment Today

Positron emission tomography (PET) is an imaging procedure that is unique by virtue of its ability to image biochemical reactions and physiological functions. This is accomplished by measuring concentrations of radioactive chemicals that are partially metabolized in the body region of interest.

PET with fluorodeoxyglucose (FDG) has been quite successful in the imaging evaluation of a large number of tumor types. Prostate cancer, however, has variable accumulation of FDG, which is probably a reflection of the heterogeneous nature of the disease. Early studies of FDG-PET in prostate cancer have shown that FDG accumulation in the primary prostate cancer may be low and overlap with the uptake in benign prostatic hyperplasia, in normal gland, and in postoperative scar or local recurrence. However, animal and preliminary clinical studies have demonstrated that FDG-PET may be useful in the evaluation of advanced disease and in patients with high Gleason scores and serum prostate-specific antigen (PSA) levels, in the detection of active osseous and soft tissue metastases, and in the assessment of response after androgen ablation and treatment with novel chemotherapies.

NCCN now does recommend PET for prostate cancer staging and restaging. There has been a recent shift in this are with the availability of mew contrast materials, including choline, PMSA and the recent approval of Axilium. NCCN now does recommend PET for prostate cancer staging and restaging. In the seminal publication26 leading to FDA approval in 2012, fluciclovine-PET/CT was found superior to CT alone at detecting local and distant recurrences, with a sensitivity of 88.6% and accuracy of 78.4%. In another study, fluciclovine-PET/CT was compared with 11C-choline-PET/CT, and it showed superiority for detecting local (in-gland, nodal, and prostatectomy bed) recurrences, especially in those with low PSA values.

MRI may be helpful to assess local invasion. Current recommendations vary; bone scan and pelvic CT or MRI are suggested for those with serum PSA >20 ng/ml or Gleason score =8, or for stage T3 or T4 disease. It is indicated to do a MRI (NCCN, p.6) under some circumstances.

MCG, Ambulatory Care, PET, 18th edition

NNCCN Guidelines for Prostate Cancer
V.2.2017

UpToDate. V.25.5
Prostate cancer: Risk stratification and choice of initial treatment
Author: Eric A Klein, MD
Literature review current through: Oct 2017. | This topic last updated: Aug 08, 2017.

UpToDate. V.25.5
Rising serum PSA following local therapy for prostate cancer: Diagnostic evaluation
Authors: Judd W Moul, MD, FACSW ; Robert Lee, MD, MS, Med
Literature review current through: Oct 2017. | This topic last updated: Feb 08, 2017

Thomas Anderson et al,
Pictorial Review of NCCN Guidelines for Use of FDG PET in Oncology. J Nucl Med May 1, 2017 vol. 58 no. supplement 1 974

Odewole OA, Tade FI, Nieh PT, et al. Recurrent prostate cancer detection with anti-3-[(18)F]FACBC PET/CT: comparison with CT. Eur J Nucl Med Mol Imaging. 2016;43:1773-1783.

Nanni C, Zanoni L, Pultrone C, et al. (18)F-FACBC (anti1-amino-3-(18)F-fluorocyclobutane-1-carboxylic acid) versus (11)C-choline PET/CT in prostate cancer relapse: results of a prospective trial. Eur J Nucl Med Mol Imaging. 2016;43:1601-1610.

Dietlein M, Kobe C, Kuhnert G, et al. Comparison of [(18)F]DCFPyL and [ (68)Ga]Ga-PSMA-HBED-CC for PSMA-PET imaging in patients with relapsed prostate cancer. Mol Imaging Biol. 2015;17:575-584.