A Guided Tour of PET in Prostate Cancer

Objectives This educational exhibit proposes a concise review of currently available applications and potential future developments in the diagnostic utility of PET in prostate cancer. After viewing this presentation, the reader will understand: 1. The depth and breadth of PET radiotracers available for use in prostate cancer imaging including: [18F]-FDG, [18F]-choline, [11C]-choline, [11C]-acetate, 16a-[18F]-fluoro-5a-dihydrotestosterone ([18F]-FDHT), anti-1-amino-3-[18F]-fluorocyclobuatane-1-carboxylic acid , prostate-specific membrane antigen (PSMA ) , gastrin-releasing peptide receptor (GRPR) and [18f]-NaF 2. The mechanism by which PET imaging conveys information on tumoral glucose metabolism: FDG-PET and its role in imaging prostate cancer. 3. The mechanism by which PET imaging relays information on tumoral lipogenesis: [18F]-choline, [11C]-choline, [11C]-acetate and the role for imaging lipogenesis in prostate cancer. 4. The mechanism by which PET imaging can provide information on amino acid transportation: anti-1-amino-3-[18F]-fluorocyclobuatane-1-carboxylic acid and the role for imaging with these radiotracers in prostate cancer. 5. The mechanism by which [18F]-NaF provides imaging of bony metastases and the role for its use, specifically in comparison and contrast with Tc99m-methylene diphosphonate (MDP). 6. The mechanism by which [18F]-FDHT targets the androgen receptor and its role for imaging evaluation of treatment response

Methods 1. Overview of the prevalence and pathophysiology of prostate cancer 2. Overview of the role for PET in staging and evaluation of treatment response in prostate cancer 3. Overview of each of the aforementioned radiotracers, their mechanism and specific applications in prostate cancer imaging 4. Case based review of the various radiotracers, their imaging appearance and applications

Results After reviewing this educational exhibit the reader will have an understanding of: 1. The important role molecular imaging plays in prostate cancer staging and continued treatment planning 2. Currently available radiotracers for imaging prostate cancer and their appropriate use 3. Future developments in the imaging of prostate cancer

Conclusions Prostate cancer is a major public health problem in developed countries. Molecular imaging plays a vital role in the initial staging and continued treatment planning for patients with prostate cancer. Currently available radiotracers, from the widely available [18F]-FDG to newer and novel radiotracers such as [18F]-PSMA offer a wide range of useful clinical information and promise a number of exciting future directions for patient care. Research Support: NIH Grants R01-CA111613 R21-CA142426 R21-EB017568 P30-CA014089 References: 1. Jadvar, Hossein, Wei Ye, Susan Groshen, and Peter S. Conti. "[F-18]-fluorodeoxyglucose PET-CT of the Normal Prostate Gland." Ann Nucl Med Annals of Nuclear Medicine 22.9 (2008): 787-93. 2. Jadvar, Hossein. "Molecular Imaging of Prostate Cancer: PET Radiotracers." American Journal of Roentgenology 199.2 (2012): 278-91. 3. Jadvar, Hossein. "Imaging Evaluation of Prostate Cancer with 18F-fluorodeoxyglucose PET/CT: Utility and Limitations." European Journal of Nuclear Medicine and Molecular Imaging Eur J Nucl Med Mol Imaging 40.S1 (2013): 5-10. 4. Jadvar, H. "PSMA PET in Prostate Cancer." Journal of Nuclear Medicine 56.8 (2015): 1131-132. 5. Jadvar, Hossein. "Prognostic Utility of PET in Prostate Cancer." PET Clinics 10.2 (2015): 255-63. 6. Jadvar, Hossein. "Can Choline PET Tackle the Challenge of Imaging Prostate Cancer?" Theranostics 2.3 (2012): 331-32. 7. Jadvar, Hossein, Kai Chen, and Osamu Ukimura. "Targeted Prostate Gland Biopsy With Combined Transrectal Ultrasound, MpMRI, and 18F-FMAU PET/CT." Clinical Nuclear Medicine 40.8 (2015).