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

Abstract

Prostate cancer is a prevalent public health problem worldwide. While imaging has played a major role in this disease, there still remain many challenges and opportunities. Positron emission tomography with various physiologically based radiotracers is fundamentally suited to interrogate this biologically and clinically heterogeneous disease along the course of its natural history. In this article, I review briefly the published evidence for the use of positron emission tomography with 18F-fluorodeoxyglucose, 11C-acetate, and 18F- or 11C-choline in the imaging evaluation of prostate cancer. Although the focus of the article will be on these radiotracers given the accumulated experience with them, but I will also comment on the outlook for the use of other emerging PET radiotracers such as those targeted to the prostate-specific membrane antigen and the amino acid metabolism pathway. It is anticipated that PET will play major role in the evaluation of prostate cancer in the current evidence-based medicine environment. There will also be exciting novel prospects for the use of therapeutic-diagnostic (theransotic) pairs in the management of patients with prostate cancer.

Exploring new frontiers in prostate cancer research: Report from the 2022 Coffey−Holden prostate cancer academy meeting

“…FDG PET SUM was also prognostic for OS in a study in 45 patients with mCRPC initiating their first or second line of chemotherapy 171 . Studies also suggest that FDG PET may be a better indicator of treatment response than standard CT or bone scan in patients with mCRPC 172 . A study was done to compare PERCIST 1.0 (FDG PET Response Criteria in Solid Tumors) to RECIST 1.1 and PSA as measures of treatment response and outcomes in 47 patients with mCRPC at baseline and 4 months post‐initiation of chemotherapy 173 .…”

A review of prostate cancer imaging, positron emission tomography, and radiopharmaceutical-based therapy

“…Several radiopharmaceuticals can be used with PET (either PET/CT or PET/MRI) scanners, such as 18 F-labeled fluorodeoxyglucose ( 18 F-FDG), 18 F-labeled sodium fluoride ( 18 F-NaF), 11 C-or 18 F-labeled choline, 11 C-or 18 F-labeled acetate, 18 F-labeled FACBC ( 18 F-fluciclovine), and the prostate-specific membrane antigen (PSMA) family of radiopharmaceuticals. Although the optimal radiopharmaceutical has not yet been defined, a few have been extensively studied and approved for use in other countries (e.g., 18 F-FDG, 18 F-NaF, 11 C-choline, and 18 F-fluciclovine are approved by the U.S. Food and Drug Administration); 27 in Canada, access to PSMA PET is starting to shape patient management. Best practice is likely to change in the near future regarding the use PET in the diagnostic and treatment approach to men with prostate cancer.…”

Positron emission tomography (PET) in primary prostate cancer staging and risk assessment

“…On the other hand, a recent review suggests that, 18 F-FDG might be helpful for restaging purposes in patients with advanced PCa metastatic disease. However, evidence for its value in the initial staging of PCa remains scant and it is not recommended ( 21 , 22 ). Despite its wide availability and use in cancer imaging, 18 F-FDG PET/CT has low specificity for PCa, and consequently, its use is reserved for late stage metastatic disease.…”