PET and MRI for prostate cancer – pro

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. Additional studies are underway to investigate the specific clinical situations in which FDG-PET may be useful in the imaging assessment of men with prostate cancer. A phase II/III trial is currently exploring this question.

NCCN does not recommend PET for prostate cancer staging but recommends bone scan(PROS-1). Similarly in the situation of rising PSA it recommends bone scan and MRI and not PET(PROS-6)

MRI may be helpful to assess local invastion. 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

NCCN, Prostte Cancer 2013

Med Solutions Oncology and PET Imaging guideline, Vs. 15.0, 1/15/13

Morris NJ, Akhurst T, Osman I, et al. Fluorinated deoxyglucose positron emission tomography imaging in progressive metastatic prostate cancer. Urology. 2002;59:913-918. A

Picchio M, Messa C, Landoni C, et al. Value of [11C]choline-positron emission tomography for re-staging prostate cancer: a comparison with [18F]fluorodeoxyglucose-positron emission tomography. J Urol. 2003;169:1337-1340.

Larson SM, Morris M, Gunther I, et al. Tumor localization of 16beta-18F-fluoro-5alpha-dihdrotestosterone versus 18F-FDG in patients with progressive, metastatic prostate cancer. J Nucl Med. 2004;45:366-373.

Morris MJ, Schoder H, Smith-Jones P, et al. Pilot trial of [18F]fluoro-dihydro-testosterone (FDHT) and FDG PET imaging in patients with castrate metastatic prostate cancer. Program and abstracts of the 2nd Annual Multidisciplinary Prostate Cancer Symposium; February 24-26, 2006; San Francisco, California. Abstract 144

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