Functional Imaging for Prostate Cancer: Therapeutic Implications

Abstract

Functional radionuclide imaging modalities, now commonly combined with anatomical imaging modalities CT or MRI (SPECT/CT, PET/CT, and PET/MRI) are promising tools for the management of prostate cancer particularly for therapeutic implications. Sensitive detection capability of prostate cancer using these imaging modalities is one issue; however, the treatment of prostate cancer using the information that can be obtained from functional radionuclide imaging techniques is another challenging area. There are not many SPECT or PET radiotracers that can cover the full spectrum of the management of prostate cancer from initial detection, to staging, prognosis predictor, and all the way to treatment response assessment. However, when used appropriately, the information from functional radionuclide imaging improves, and sometimes significantly changes, the whole course of the cancer management. The limitations of using SPECT and PET radiotracers with regards to therapeutic implications are not so much different from their limitations solely for the task of detecting prostate cancer; however, the specific imaging target and how this target is reliably imaged by SPECT and PET can potentially make significant impact in the treatment of prostate cancer. Finally, while the localized prostate cancer is considered manageable, there is still significant need for improvement in noninvasive imaging of metastatic prostate cancer, in treatment guidance, and in response assessment from functional imaging including radionuclide-based techniques. In this review article, we present the rationale of using functional radionuclide imaging and the therapeutic implications for each of radionuclide imaging agent that have been studied in human subjects.

Multisite Experience of the Safety, Detection Rate and Diagnostic Performance of Fluciclovine ( 18 F) Positron Emission Tomography/Computerized Tomography Imaging in the Staging of Biochemically Recurrent Prostate Cancer

“…PSMA targeted 111 In capromab pendetide demonstrates suboptimal diagnostic performance, 19 ( 18 F) FDG PET/CT provides low sensitivity, 20 ( 18 F)-fluoride PET is limited to the detection of bone metastases, country specific regulatory approval restricts 18 F-choline PET/CT use in Europe and the short half-life of 11 C-choline confines its use in the United States to centers with a cyclotron on site. Second generation PSMA targeting agents show promise but are still early in formal development.…”

Preclinical Comparison of Al18F- and 68Ga-Labeled Gastrin-Releasing Peptide Receptor Antagonists for PET Imaging of Prostate Cancer

“…Emerging functional imaging techniques, including diffusion-weighted MR imaging, dynamic contrastenhanced MR imaging, and PET, have shown improved sensitivity and staging accuracy for detecting primary prostate tumors and metastatic lymph nodes (3). Several PET radiotracers have shown promising clinical utility, such as the metabolic agents 18 F-FDG, 11 C-/ 18 F-choline, and 11 C-/ 18 F-acetate for the assessment of distant metastasis and 18 F-NaF for the detection of bone metastasis (4). However, their application is most valuable in late-stage, recurrent, or metastatic PCa.…”

[14C]Fluciclovine (alias anti-[14C]FACBC) uptake and ASCT2 expression in castration-resistant prostate cancer cells

“…Diagnostic imaging techniques such as SPECT and PET are useful tools for detection of PCa [10]. For [15].…”