The Roles of PET and PET/CT in the Diagnosis and Management of Prostate Cancer

Abstract

2-¹⁸F-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) imaging in prostate cancer is challenging because glucose utilization in well-differentiated prostate cancer is often lower than in other tumor types. Nonetheless, FDG-PET has a high positive predictive value for untreated metastases in viscera, but not lymph nodes. A positive FDG-PET can provide useful information to aid the clinician’s decision on future management in selected patients who have low prostate-specific antigen levels and visceral changes as a result of metastases. On the other hand, FDG-PET is limited in the identification of prostate tumors, as normal urinary excretion of radioisotope can mask pathological uptake. Moreover, there is an overlap in the degree of uptake between prostate cancer, benign prostatic hyperplasia and inflammation. The tracer choice is also important. ¹¹C-choline has the advantage of reduced urinary excretion, and thus ¹¹C-choline PET may provide more accurate information on the localization of main primary prostate cancer lesions than MRI or MR spectroscopy. ¹¹C-choline PET is sensitive and accurate in the preoperative staging of pelvic lymph nodes in prostate cancer. A few studies are available but there were no PET or PET/CT studies with a large number of patients for tissue confirmation of prostate cancer; further investigations are required.

In Vivo Imaging of Prostate Cancer Using [68Ga]-Labeled Bombesin Analog BAY86-7548

“…The most common tracer, 2 [ 18 F]fluoro-2-deoxy-D-glucose (FDG), has a low sensitivity for detecting early prostate cancer due to the low glucose consumption (9,10), limiting the possibility to detect clinically localized disease. Other tracers, such as 18 F-or 11 C-labeled choline and [ 11 C]-acetate, are used mainly for the diagnosis of recurrent (11)(12)(13) or metastatic (14) prostate cancer.…”

Targeting Free Prostate-Specific Antigen forIn VivoImaging of Prostate Cancer Using a Monoclonal Antibody Specific for Unique Epitopes Accessible on Free Prostate-Specific Antigen Alone

“…First, the accumulation of the mAb [PSA30] in necrotic areas of solid tumors is generally accepted to be a result of the enhanced permeability and retention effect 42,43 ; second, it is also well documented that the major downfalls of metabolic probes, for example, 18 F -choline and 18 F-FDG, are their unspecificity toward malignancies but more tendency to accumulate in areas of inflammation. [44][45][46][47] These findings demonstrate that PSA30 has a potential to serve as an independent marker for PCa imaging that might provide information above and beyond the scope of metabolic and proliferative status. This might be important because all studies indicate the heterogeneity of PCa and hence the I-PSA30 kinetics in the major organs of nude mice (n = 14) presented as percent change in %IA/g from the first measurement in a semilogarithmic scale.…”

Roles of facilitative glucose transporter GLUT1 in [18F]FDG positron emission tomography (PET) imaging of human diseases

“…[124,125]. An enhanced expression of GLUT1 is found in prostate carcinoma cells, which includes a novel co-localisation of GLUT1 with a Golgi marker.…”