11C-Acetate PET Imaging of Prostate Cancer: Detection of Recurrent Disease at PSA Relapse

¹¹C-Acetate PET Imaging of Prostate Cancer: Detection of Recurrent Disease at PSA Relapse

Nobuyuki Oyama, MD, PhD¹^,2, Tom R. Miller, MD, PhD¹^,2, Farrokh Dehdashti, MD¹^,2, Barry A. Siegel, MD¹^,2, Keith C. Fischer, MD¹, Jeff M. Michalski, MD¹^,2, Adam S. Kibel, MD²^,3, Gerald L. Andriole, MD²^,3, Joel Picus, MD²^,4 and Michael J. Welch, PhD¹^,2

¹ Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
² The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
³ Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
⁴ Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri

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FIGURE 1. Coronal ¹⁸F-FDG PET (A) and AC PET (B) images are shown for patient 14, 77-y-old man with PSA relapse and serum PSA value of 10.5 ng/mL 8 y after radical prostatectomy and 5 y after salvage external-beam radiation therapy. Histologic diagnosis showed Gleason score of 8 at surgery. CT and ¹¹¹In-capromab pendetide studies were negative for tumor. ¹⁸F-FDG PET shows only urinary activity in right ureter (u) and bladder (b). AC PET shows high uptake in multiple paraaortic lymph nodes (n). Incidentally noted is normal uptake in pancreas (panc).

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FIGURE 2. Coronal images are shown for patient 3, 71-y-old man with PSA relapse and serum PSA value of 3.7 ng/mL 8 y after radical prostatectomy. Histologic diagnosis showed Gleason score of 10 at surgery. (A) ¹⁸F-FDG PET is negative for tumor. (B) AC PET shows high uptake in right common iliac lymph node (n) and prostatic bed (pr).

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FIGURE 3. Coronal and transaxial ¹⁸F-FDG PET (A) and AC PET (B) images and CT image (C) are shown for patient 23, 73-y-old man with increasing serum PSA value of 9.1 ng/mL 2 y after external-beam radiation therapy. Histologic diagnosis showed Gleason score of 7 at time of treatment. ¹⁸F-FDG PET shows no uptake in prostate and pelvic lymph nodes. AC PET shows bilateral high uptake in iliac lymph nodes (n). CT shows corresponding 1.5 cm iliac nodes (n).

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FIGURE 4. AC PET results are shown as function of PSA level. Thirteen of 22 patients with serum PSA level > 3 ng/mL had positive AC PET findings, whereas only 1 of 24 patients with serum PSA level $<=$ 3 ng/mL had positive findings.