Laparoscopic extended pelvic lymph node (LN) dissection as validation of the performance of [¹¹C]‐acetate positron emission tomography/computer tomography in the detection of LN metastasis in intermediate‐ and high‐risk prostate cancer

Abstract

ObjectivesTo evaluate the accuracy of the radiopharmaceutical [ 11 C]-acetate combined with positron emission tomography/ computer tomography (acetate-PET/CT) in lymph node (LN) staging in newly diagnosed prostate cancer cases. A second aim was to evaluate the potential discriminative properties of acetate-PET/CT in clinical routine. Patients and MethodsIn a prospective comparative study, from July 2010 to June 2013, 53 men with newly histologically diagnosed intermediate-or high-risk prostate cancer underwent acetate-PET/CT investigation at one regional centre before laparoscopic extended pelvic LN dissection (ePLND) at one referral centre. The sensitivity, specificity and accuracy of acetate-PET/CT were calculated. Comparisons were made between true-positive and false-negative PET/CT cases to identify differences in the clinical parameters: PSA level, Gleason status, lymph metastasis burden and size, calculated risk of LN involvement, and curative treatment decisions. ResultsIn all, 26 patients had surgically/histologically confirmed LN metastasis (LN+). Acetate-PET/CT was true positive in 10 patients, false positive in one, false negative in 16, and true negative in 26. The individual sensitivity was 38%, specificity 96%, and accuracy 68%. The acetate-PET/CT positive cases had significantly more involved LNs (mean 7.9 vs 2.4, P < 0.001) with larger cancer diameters (14.1 vs 4.9 mm, P = 0.001) and fewer eventually had treatment with curative intent (40% vs 94%, P <0.005), although we lack long-term outcome data. ConclusionAcetate-PET/CT has too low a sensitivity for routine LN staging but the specificity is high. The acetate-PET/CT positive cases have a very high burden of LN spread.

Carbon Flux as a Measure of Prostate Cancer Aggressiveness: [11C]-Acetate PET/CT

“…In this study, the kinetics of [ 11 C]-acetate uptake in PCa subjects and prostate cancer cell lines were investigated. [ 11 C]-acetate has previously been used for whole-body PET/CT imaging in PCa patients in primary staging and to localize the biochemical recurrent lesions in patients after primary treatment [20,[29][30][31][32][33]. In this study, we applied a simple single-tissue compartment model to describe and visualize [ 11 C]-acetate uptake kinetics with the aim to investigate the underlying uptake mechanism and respective tumor biology.…”

Comparison of 68Ga-PSMA-11 PET/CT with 11C-acetate PET/CT in re-staging of prostate cancer relapse

“…But with our previous experience, most of the benign lesions with mild uptake on acetate-PET and appearance on CT examination, particularly in inguinal and mediastinal regions are identified and discarded. Applying the similar method, diagnostic accuracy of acetate-PET was improved with the specificity optimised to 98% 40,41 .…”

MRI and 11C acetate PET/CT for prediction of regional lymph node metastasis in newly diagnosed prostate cancer

“…All patients in our study have been included in two previous studies 11 , 18 that focused on nonquantitative validation of MRI DWI and 11 C acetate PET/CT.…”

“… 13 , 14 , 15 , 16 There are a few publications on lymph node staging in PCa with the PET radiotracer 11 C acetate. 17 , 18 Acetate can be metabolized in different ways, the most important in PCa is the fatty acid synthase pathway (FAS), as this pathway is overexpressed in PCa. 19 , 20 , 21 The uptake of this tracer can be measured semi-quantitatively by the standardized uptake value (SUV).…”