Prostate cancer–specific PET radiotracers: A review on the clinical utility in recurrent disease

Abstract

Prostate cancer-specific positron emission tomography (pcPET) has been shown to detect sites of disease recurrence at serum prostate-specific antigen (PSA) levels that are lower than those levels detected by conventional imaging. Commonly used pcPET radiotracers in the setting of biochemical recurrence are reviewed including carbon 11/fludeoxyglucose 18 (F-18) choline, gallium 68/F-18 prostate-specific membrane antigen (PSMA), and F-18 fluciclovine. Review of the literature generally favors PSMA-based agents for the detection of recurrence as a function of low PSA levels. Positive gallium 68/F-18 PSMA positron emission tomography/computed tomography scans detected potential sites of recurrence in a median 51.5% of patients when PSA level is <1.0 ng/mL, 74% of patients when PSA level is 1.0 to 2.0 ng/mL, and 90.5% of patients when PSA level is >2.0 ng/mL. Review of carbon 11/fludeoxyglucose 18 (F-18) choline and F-18 fluciclovine data commonly demonstrated lower detection rates for each respective PSA cohort, although with some important caveats, despite having similar operational characteristics to PSMA-based imaging. Sensitive pcPET imaging has provided new insight into the early patterns of disease spread, which has prompted judicious reconsideration of additional local therapy after either prostatectomy, definitive radiation therapy, or postprostatectomy radiation therapy. This review discusses the literature, clinical utility, availability, and fundamental understanding of pcPET imaging needed to improve clinical practice.

Outcomes after a first and/or second salvage treatment in patients with oligometastatic prostate cancer recurrence detected by (18‐F) choline PET‐CT

“…With the addition of CT scan and median PSA of 25 ng/ml, 73% of patients can be diagnosed with ≤3 metastases (Crook et al, 2012;Schweizer et al, 2013). In the last years, the introduction of more sensitive and specific imaging modalities such as whole-body MRI (Padhani et al, 2016) and PET-CT with novel trazers (Evans et al, 2017) has been responsible for the detection of oligometastatic disease even earlier at median PSA levels between 1 and 5 ng/ml. Therefore, both the number of metastases detected and the time between a PSA rise and the detection of metastatic disease are decreasing (Ost et al, 2015).…”

18F-Positron Emitting/Trimethine Cyanine-Fluorescent Contrast for Image-Guided Prostate Cancer Management

“…While not fluorescent, these compositions have resulted in ongoing clinical trials. 33 Given the current infrastructure dedicated to clinically imaging [ 18 F]-2-fluorodeoxyglucose, we believe that a 18 F-construct for imaging PSMA primary and metastatic cancer may be advantageous.…”

Fluorescent‐functionalized graphene oxide for selective labeling of tumor cells

“…The expense of MRI limits its routine application as a screening tool, and it is uncomfortable for some patients as it may produce claustrophobia . PET scan involves radioactive tracers such as 11 C, 18 F, 68 Ga, and so forth . Although the exposure to harmful radiation is minimal, the patient often suffers from an allergic reaction from the tracers.…”

“…2 PET scan involves radioactive tracers such as 11 C, 18 F, 68 Ga, and so forth. 3 Although the exposure to harmful radiation is minimal, the patient often suffers from an allergic reaction from the tracers. Developing fetuses, child, pregnant and breastfeeding women are advised to avoid PET scan as the radiation is not considered as safe.…”