PET imaging with 11C-acetate in prostate cancer: a biochemical, radiochemical and clinical perspective

Abstract

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

A Comparison of Different Imaging Techniques for Localisation of Cancers in the Prostate

“…11 C -acetate traces endogenous acetate and is incorporated into anabolic processes such as lipid membrane and protein formation associated with proliferative activity [12]. In this study, there was a high variability in tumour uptake.…”

Radiotrazadores empleados en medicina nuclear para el diagnóstico y seguimiento del cáncer de próstata

“…La vía catabólica también influye, y el acetato puede metabolizarse a CO 2 a través del ciclo de Krebs. El acetato se usa como sustrato en algunos procesos intracelulares, dentro de la mitocondria produciendo energía y en el citosol en la síntesis de lípidos 40,41 . El 11C-acetato no puede distinguir entre la hiperplasia prostática benigna (HPB) y el CP.…”

Radiotracers Used in Nuclear Medicine for Prostate Cancer Diagnosis and Follow-Up

“…The catabolic pathway influences as well, with acetate being able to metabolize into CO 2 via the Krebs cycle. Acetate is used as a substrate in some intracellular processes within the mitochondria by producing energy and in the cytosol in the synthesis of lipids 40,41 . The 11C-acetate is unable to distinguish between benign prostatic hyperplasia (BPH) and prostate cancer.…”