11C-acetate PET/CT in pre-therapeutic lymph node staging in high-risk prostate cancer patients and its influence on disease management - a retrospective study

Abstract

BackgroundRadiation treatment with simultaneous integrated boost against suspected lymph node metastases may be a curative therapeutic option in patients with high-risk prostate cancer (>15% estimated risk of pelvic lymph node metastases according to the Cagiannos nomogram). 11C-acetate positron emission tomography/computed tomography (PET/CT) can be used for primary staging as well as for detection of suspected relapse of prostate cancer. The aims of this study were to evaluate the association between positive 11C-acetate PET/CT findings and the estimated risk of pelvic lymph node metastases and to assess the impact of 11C-acetate PET/CT on patient management in high-risk prostate cancer patients.MethodsFifty consecutive prostate cancer patients referred for primary staging with 11C-acetate PET/CT prior to radiotherapy with curative intention were enrolled in this retrospective study.ResultsAll patients showed increased 11C-acetate uptake in the prostate. Pelvic lymph node uptake was seen in 42% (21/50) of the patients, with positive external iliac lymph nodes in 71% (15/21) of these. The overall observed proportion of PET/CT-positive pelvic lymph nodes at patient level was higher than the average estimated risk, especially in low-risk groups (<15%). There was a significant association between observed proportion and estimated risk of pelvic lymph node metastases in groups with ≤45 and >45% estimated risk. Treatment strategy was altered due to 11C-acetate PET/CT findings in 43% (20/47) of the patients.ConclusionsThe observed proportion of 11C-acetate PET/CT findings suggestive of locoregional metastases was higher than the estimated risk, suggesting that the Cagiannos nomogram underestimates the risk for metastases. The imaging results with 11C-acetate PET/CT have a considerable impact on patient management.

Evaluation of Prostate Cancer with 11C-Acetate PET/CT

“…The study by Haseebuddin et al (34) suggests that prognostic information can be derived from presurgical 11 C-acetate studies. In another report, 11 C-acetate studies performed before radiation therapy altered the management in more than 40% of patients (36). These potential applications await further verification in larger prospective studies.…”

“…Another study enrolled 50 consecutive patients with highaverage serum PSA levels and Gleason scores who were scheduled to undergo primary radiation treatment (36). This group was evaluated for whether the degree and extent of 11 C-acetate PET abnormalities were associated with the estimated risk for pelvic lymph node metastases according to the nomogram described by Cagiannos et al (37).…”

Positron emission tomography in imaging evaluation of staging, restaging, treatment response, and prognosis in prostate cancer

“…Patients with positive PET scans had 3.3 times higher risk for therapy failure after surgery. Therefore, in selected intermediate to high-risk cases, 11C-acetate may provide useful information that then can lead to management change at the time of initial staging [21]. …”

Combined Photodynamic and Radiotherapy Synergistic Effect in Cancer Treatment

“…In RT the growth of cancerous cells is kept under control with ionizing radiation effect. To preventof the recurrence of cancer before and after surgical removal of primer malign tumors, RT is used in the clinic.In monitoring of therapy response, radionuclide-based imaging techniques; Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) are commonly used [33][34][35]. In addition, these techniquesalso provide the detection of deep-seated tumors Mini Review and inform about the pathophysiology and pathobiochemical processes of the tumor.In literature apoptosis mechanism was carried out by using radiotracer and PS (64Cu-DOTA-biotin-ZnPcS2 and AlPcS2) in combined PDT and RT [36], On the other hand, nuclear imaging and PDT is possible with combined some radioisotope/radiopharmaceutics and PSfortargeting metabolic actions such as hypoxia ( 123 I-IAZA/ 99m Tc-HMPAO-PII) [37][38], vascular damage ( 99m Tc-HMPAO-PII) [39], proliferation ( 18 F-FL-ATP-S 10 (Na)) [40], membrane renewal ( 11 C-Choline-Pc4) [41] or mitochondrial resistance and glucose metabolism (Bolus 18F-FDG-PII and AlPcS/Bolus 18 F-FDG-ADMP06/Bolus 18 F-FDG-Anti-CD104isothiocyanato porphyrin conjugate) [42][43][44].…”