Visualization of Prostate Cancer with Positron Emission Tomography
Introduction
Positron emission tomography (PET) using 2-[]-2-deoxy-D-glucose (FDG) as a radiopharmaceutical has been shown to be an accurate technique for tumor detection, staging and monitoring of therapy in a number of malignant tumors [1]. So far, the clinical experience with FDG-PET in prostate cancer is limited for two reasons: the uptake of FDG in prostate cancer is low and FDG is rapidly excreted in urine, causing an accumulation of activity in the bladder [2], [3], [4], [5].
Carbon-11 labeled choline (CHOL) has recently been reported as a new PET radiopharmaceutical for tumor detection [6]. Choline is one of the components of phosphatidylcholine, an essential element of phospholipids in the cell membrane [7]. Malignant tumors may show a high proliferation and increased metabolism of cell membrane components, which will lead to an increased uptake of choline [8]. First results with CHOL PET in patients with (advanced) prostate cancer showed visualization of the primary tumor and of known metastatic sites [9], [10]. In order to validate these preliminary results and further define the potential of CHOL PET, we studied CHOL PET prospectively in patients with prostate cancer.
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Patients
A total of 25 consecutive patients with histologically proven adenocarcinoma of the prostate participated in this study. The primary tumor was staged clinically according to palpatory findings and transrectal ultrasound. An MRI or a CT was performed to assess lymph node metastases pre-operatively. Patients with T4 tumors and/or known distant metastases were excluded. In addition, the uptake of CHOL in the normal prostate was studied in five patients with a bladder carcinoma who underwent
Visualization of the normal prostate
Physiological uptake of the radiopharmaceutical was noticed in the small intestine in all subjects studied. In three patients, a moderate non-specific accumulation of radioactivity was seen in the bladder region. The uptake of CHOL in the prostate was measured in five patients who underwent cystectomy for bladder tumors with a mean SUV of 2.3 (range 1.3–3.2). Histology of the operation specimens excluded malignancy and showed benign hyperplasia in four patients (Table 1).
Visualization of prostate cancer
In the prostate tumor,
Discussion
The most widely used PET radiopharmaceutical in oncology is FDG. However, FDG shows major drawbacks in prostate cancer. As the uptake of FDG in prostate cancer is low, the differentiation between cancer and benign hyperplasia is not possible using FDG-PET [5]. Moreover, the radiotracer is excreted into the bladder. High levels of radioactivity in the bladder interfere with radioactivity accumulation in the prostate area and can mask small tumors or metastases in the pelvic area. Bladder
Conclusion
Carbon-11-choline is avidly taken up in prostate cancer, both primary tumor and lymph node metastases, in the virtual absence of urinary radioactivity. These results confirm the early results obtained by others and permit further clinical research on the value of CHOL PET as a metabolic imaging technique in areas where conventional imaging have a limited sensitivity.
References (22)
- et al.
Metabolic imaging of untreated prostate cancer by positron emission tomography with 18F-fluorine-labeled deoxyglucose
J. Urol.
(1996) - et al.
Positron emission tomography in urological oncology
J. Urol.
(1998) - et al.
The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy
J. Urol.
(1995) - Reske SN, Kozerke J. FDG-PET for clinical uses. Results of the 3rd German Interdisciplinary Consensus Conference,...
- et al.
Metastatic prostate cancer: Initial findings of PET with 2-deoxy-2[18F]fluoro-D-glucose
Radiology
(1996) - et al.
Fluorine-18-fluordeoxyglucose positron emission tomography is useless for detection of local recurrence after radical prostatectomy
Eur. Urol.
(1999) - et al.
Imaging of brain tumor, lung cancer, esophageal cancer, colon cancer, prostate cancer and bladder cancer with (C-11)choline
J. Nucl. Med.
(1997) Dietary choline: biochemistry, physiology and pharmacology
Annu. Rev. Nutr.
(1981)Tumor phospholipid metabolism
NMR Biomed.
(1999)- et al.
PET imaging of prostate cancer using carbon-11-choline
J. Nucl. Med.
(1998)
Experience with carbon-11 choline positron emission tomography in prostate carcinoma
Eur. J. Nucl. Med.
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