Challenges in Clinical Prostate Cancer: Role of Imaging

Kelloff, Gary J.; Choyke, Peter L.; Coffey, Donald S.

doi:10.2214/ajr.09.2579

Cited by 167 publications

(129 citation statements)

References 97 publications

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“…21 The contributors were less convinced of the current role of imaging in the diagnostic pathway for these men. 22 There was overall agreement that multiparametric functional MRI and new TRUS techniques show promising results in multiple centers and publications in relation to characterizing men with prostate cancer and localizing their tumor. Based on these results, it is expected that these techniques will play a major role in the future for the selection, performance, and follow-up of patients with focal therapy.…”

Section: Assessment Of Patients Who May Be Candidates For Focal Therapymentioning

confidence: 74%

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

Rosette

Ahmed

Barentsz³

et al. 2010

Journal of Endourology

170

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Purpose: To establish a consensus in relation to case selection, conduct of therapy, and outcomes that are associated with focal therapy for men with localized prostate cancer. Material and Methods: Urologic surgeons, radiation oncologists, radiologists, and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer. The consensus process was face to face within a structured meeting, in which pertinent clinical issues were raised, discussed, and agreement sought. Where no agreement was possible, this was acknowledged, and the nature of the disagreement noted. Results: Candidates for focal treatment should have unilateral low-to intermediate-risk disease with clinical stage cT 2a . Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used. Currently, the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies. MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results. For general use, however, these new techniques require validation in prospective clinical trials. Until such are performed, MRI will, in most centers, continue to be an investigative tool in assessing eligibility of patients for focal therapy. Conclusions: Consensus was derived for most of the key aspects of case selection, conduct of treatment, and outcome measures for men who are undergoing focal therapy for localized prostate cancer. The level of agreement achieved will pave the way for future collaborative trials.

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Section: Assessment Of Patients Who May Be Candidates For Focal Therapymentioning

confidence: 74%

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

Rosette

Ahmed

Barentsz³

et al. 2010

Journal of Endourology

170

View full text Add to dashboard Cite

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“…A detectable or rising PSA level after therapy is considered to indicate biochemical recurrence, or "PSA failure," even when there are no symptoms or signs of locally recurrent or metastatic disease (1,2). By enabling selection of appropriate treatment, such as local salvage therapy or systemic therapy, imaging is useful for identifying locally recurrent or distant lesions when the PSA level is rising (3).…”

mentioning

confidence: 99%

Pilot Comparison of ⁶⁸Ga-RM2 PET and ⁶⁸Ga-PSMA-11 PET in Patients with Biochemically Recurrent Prostate Cancer

et al. 2015

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Glu-NH-CO-NH-Lys-(Ahx)-[ 68 Ga(HBED-CC)] ( 68 Ga-PSMA-11) is a PET tracer that can detect prostate cancer relapses and metastases by binding to the extracellular domain of PSMA. 68 Ga-labeled DOTA-4-amino-1-carboxymethyl-piperidine-D-Phe-Gln-Trp-AlaVal-Gly-His-Sta-Leu-NH2 ( 68 Ga-RM2) is a synthetic bombesin receptor antagonist that targets gastrin-releasing peptide receptors. We present pilot data on the biodistribution of these PET tracers in a small cohort of patients with biochemically recurrent prostate cancer. Methods: Seven men (mean age ± SD, 74.3 ± 5.9 y) with biochemically recurrent prostate cancer underwent both 68 Ga-PSMA-11 PET/ CT and 68 Ga-RM2 PET/MRI scans. SUV max and SUV mean were recorded for normal tissues and areas of uptake outside the expected physiologic biodistribution. Results: All patients had a rising level of prostate-specific antigen (mean ± SD, 13.5 ± 11.5) and noncontributory results on conventional imaging. 68 Ga-PSMA-11 had the highest physiologic uptake in the salivary glands and small bowel, with hepatobiliary and renal clearance noted, whereas 68 Ga-RM2 had the highest physiologic uptake in the pancreas, with renal clearance noted. Uptake outside the expected physiologic biodistribution did not significantly differ between 68 Ga-PSMA-11 and 68 Ga-RM2; however, 68 Ga-PSMA-11 localized in a lymph node and seminal vesicle in a patient with no abnormal 68 Ga-RM2 uptake. Abdominal periaortic lymph nodes were more easily visualized by 68 Ga-RM2 in two patients because of lack of interference by radioactivity in the small intestine. Conclusion: 68 Ga-PSMA-11 and 68 Ga-RM2 had distinct biodistributions in this small cohort of patients with biochemically recurrent prostate cancer. Additional work is needed to understand the expression of PSMA and gastrinreleasing peptide receptors in different types of prostate cancer.

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“…Although preliminary studies have demonstrated that 11 C-acetate is a promising tracer for diagnosis of recurrent (8)(9)(10) or metastatic (11) prostate cancer, its use in primary diagnosis is less well established. In particular, the clinical role of 11 C-acetate in prostate cancer detection and staging is currently unclear (12,13). In vitro studies indicate that 11 C-acetate as a marker of enhanced lipid synthesis is appropriate for estimating the growth activity of tumor cells (14,15).…”

mentioning

confidence: 99%

Functional Imaging of Localized Prostate Cancer Aggressiveness Using ¹¹C-Acetate PET/CT and ¹H-MR Spectroscopy

Jambor¹,

Borra²,

Kemppainen³

et al. 2010

J Nucl Med

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We assessed the ability of 11 C-acetate PET/CT, MRI, and proton MR spectroscopy ( 1 H-MRS) to image localized prostate cancer and detect its aggressiveness, using qualitative and quantitative approaches. Methods: Twenty-one patients with untreated localized prostate cancer, diagnosed using transrectal ultrasound-guided biopsy, were prospectively enrolled. Cancer laterality was based on the percentage of cancer and the highest Gleason score determined from biopsies. In addition to PET/CT, 3-dimensional 1 H-MRS of the entire prostate volume using a quantitative approach was performed. The imaging and histologic findings of 8 patients undergoing subsequent prostatectomy were compared on a sextant level. For each lobe and sextant, standardized uptake values (SUVs) and (choline 1 creatine 1 polyamines)-to-citrate (CCP/C) ratios were obtained from 11 C-acetate PET/CT and 1 H-MRS, respectively. The visual and quantitative findings on PET/CT and MRI data were compared with cancer laterality and aggressiveness based on the Gleason score and with prostate-specific antigen (PSA) velocity and international risk group classification. Results: The sensitivity, specificity, and accuracy, on a lobar level using visual analysis, of 11 C-acetate PET/CT were 80%, 29%, 71%, respectively, and 89%, 29%, 79%, respectively, using contrastenhanced MRI. The sensitivity and accuracy of 11 C-acetate PET/CT decreased to 64% and 63% and specificity increased to 62% when sextant analysis was performed. The agreement between prostate cancer laterality based on biopsy findings and visual interpretation of 11 C-acetate PET/CT and contrastenhanced MRI was similar at 71%. The mean SUV maximum and CCP/C maximum for the dominant tumor lesion were 5.5 and 1.48, respectively, and did not differ significantly from values in the nondominant lobe. The dominant-lesion SUVs or CCP/C values were not associated with histologically determined prostate cancer aggressiveness, nor did PSA velocity correlate with the SUV or CCP/C values from the entire gland.Conclusion: 11 C-acetate PET/CT, MRI, and 1 H-MRS enable detection of localized prostate cancer with comparable and limited accuracy but fail to provide information on cancer aggressiveness.

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Challenges in Clinical Prostate Cancer: Role of Imaging

Cited by 167 publications

References 97 publications

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

Pilot Comparison of ⁶⁸Ga-RM2 PET and ⁶⁸Ga-PSMA-11 PET in Patients with Biochemically Recurrent Prostate Cancer

Functional Imaging of Localized Prostate Cancer Aggressiveness Using ¹¹C-Acetate PET/CT and ¹H-MR Spectroscopy

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Challenges in Clinical Prostate Cancer: Role of Imaging

Cited by 167 publications

References 97 publications

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

Focal Therapy in Prostate Cancer—Report from a Consensus Panel

Pilot Comparison of 68Ga-RM2 PET and 68Ga-PSMA-11 PET in Patients with Biochemically Recurrent Prostate Cancer

Functional Imaging of Localized Prostate Cancer Aggressiveness Using 11C-Acetate PET/CT and 1H-MR Spectroscopy

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Product

Resources

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Pilot Comparison of ⁶⁸Ga-RM2 PET and ⁶⁸Ga-PSMA-11 PET in Patients with Biochemically Recurrent Prostate Cancer

Functional Imaging of Localized Prostate Cancer Aggressiveness Using ¹¹C-Acetate PET/CT and ¹H-MR Spectroscopy