Purpose In the present study, the potential clinical role of 11 C-acetate PET mainly in the differential diagnosis, in the staging and in the follow-up of prostate cancer patients is reported. Methods Each of the above points has been accurately investigated by studying the specific biochemical and radiobiochemical behaviour of this positron emitter compound. Results and Conclusion The imaging quality of 11 C-acetate PET and its unique mechanisms of cellular uptake, make such radiotracer a powerful tool in evaluating all the steps of the prostatic cancer.Keywords PET imaging . 11 C-acetate . Prostate cancer . Biochemical perspective . Radiochemical perspective . Clinical perspective Radiolabelled acetate is a simple metabolic probe used in the study of healthy and malignant tissues, organs and glands. The use of labelled acetate in biochemical research started decades ago, and involved studying glial metabolism in the brain by MRI and myocardial metabolism by PET. A new potential for the use of this molecule in conjunction with 11 C has been established for use in oncological PET investigations.Clinical experience in some of our institutions in imaging prostate cancer by PET with 11 C-acetate appeals to the wider use of this tracer provided that the core questions underlying its biochemistry are solved. Preliminary studies performed at Castelfranco Veneto PET centre have allowed accurate "de novo" diagnosis of prostate cancer with a very low rate of false-positive cases (global accuracy approaching 90%), thus potentially playing an important role in early differential diagnosis between benign and malignant prostate lesions [1]. Moreover, the use of 11 C-acetate PET at Geneva University Hospital in the clinical setting of prostate cancer relapse after radical surgery allowed the detection of recurrences at a very early phase, i.e. in patients having only slightly increased PSA levels (lower than 0.8 ng/ml) [2]. This article deals on the early and current use of radiolabelled acetate with an attempt to understand the underlying biochemical and radiochemical principles that play a role in its applications.
Early research with 11 C-acetateThe use of 11 C-acetate on animals and humans started in the early 1980s to study myocardial metabolism [3] and proved useful in patients with coronary heart disease. In these studies, a correlation between radioactivity washout from Eur J Nucl Med Mol Imaging (2008) 35:942-949
We report the results of FDG PET whole body scan in 75 cancer patients in whom tumor extent was defined by surgical, histological or cytological findings and clinical follow-up. Twenty-five had malignant lymphomas, 24 lung carcinomas, and 26 other types of solid tumors. Twenty-three patients were evaluated at disease onset, before therapy, and 37 at the moment of tumor recurrence; the remaining 15 patients were in complete remission after treatment and were taken as controls. Visual and quantitative PET results were compared with conventional imaging (US, CT scan and/or MRI, and Tc99m MDP bone scan). In the 60 patients with active disease, PET as well as conventional imaging were able to locate the primary tumor in all 23 patients studied at disease onset. However, with regard to lymph node and distant metastases, PET provided the same information as conventional imaging in 31 cases (51.6%), but revealed further neoplastic foci in 29 cases (48.4%), 21 in lymph nodes and 8 at distant sites. The sensitivity of PET, in comparison with conventional imaging, was 100% versus 100% for the detection of the primary tumor, 97.6% versus 55.8% for the localization of node metastases, and 100% versus 55.5% for the visualization of distant metastases. The specificity, calculated in the group of 15 disease-free patients, was 100% for PET and 86.6% for conventional imaging. The therapeutic approach was modified in 12 patients (20%) on the basis of the PET results. Furthermore, in 14 cases (23.3%) with advanced disease, PET provided complete information on tumor spread, otherwise obtainable only by taking together the results of all other diagnostic procedures. Our data indicate a higher accuracy of FDG PET whole body scan compared to conventional imaging techniques in the evaluation of metastatic spread both at initial diagnosis and during follow-up, with an important impact on therapeutic decision-making. Moreover, by providing complete information on tumor spread in some cases, PET can become a profitable tool in terms of cost reduction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.