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Molecular imaging of prostate cancer with 18F-fluorodeoxyglucose PET

Nature Reviews Urology volume 6, pages 317–323 (2009)Cite this article

Abstract

Prostate cancer poses a major public health problem, particularly in the US and Europe, where it constitutes the most common type of malignancy among men, excluding nonmelanoma skin cancers. The disease is characterized by a wide spectrum of biological and clinical phenotypes, and its evaluation by imaging remains a challenge in view of this heterogeneity. Imaging in prostate cancer can be used in the initial diagnosis of the primary tumor, to determine the occurrence and extent of any extracapsular spread, for guidance in delivery and evaluation of local therapy in organ-confined disease, in locoregional lymph node staging, to detect locally recurrent and metastatic disease in biochemical relapse, to predict and assess tumor response to systemic therapy or salvage therapy, and in disease prognostication (in terms of the length of time taken for castrate-sensitive disease to become refractory to hormones and overall patient survival). Evidence from animal-based translational and human-based clinical studies points to a potential and emerging role for PET, using F-fluorodeoxyglucose as a radiotracer, in the imaging evaluation of prostate cancer.

Key Points

  • Generally, high uptake of 18F-fluorodeoxyglucose (FDG) is expected in prostate tumors that are poorly differentiated, hypoxic and have a high Gleason score

  • Glucose metabolism in prostate tumors is modulated by androgen; FDG-PET can, therefore, be useful in monitoring response to androgen deprivation therapy

  • FDG-PET has limited use in diagnosis and staging of clinically organ-confined disease and can be falsely negative or falsely positive

  • FDG-PET might be useful for diagnosing and staging primary tumors, detecting locally recurrent and/or metastatic disease, assessing the extent of metabolically active castrate-resistant disease, monitoring treatment responses and in prognostication

  • Results from the NOPR show that FDG-PET influenced clinical management in 35.1% of prostate cancer cases

  • Different PET radiotracers are likely to be suited to various clinical states of prostate cancer, taking advantage of the most relevant biological markers of disease

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Figure 1: FDG-PET and CT scans of locally recurrent and metastatic prostate cancer.
Figure 2: Fused FDG-PET–CT scans in a patient with castrate-sensitive disease a | before and b | after androgen deprivation therapy.
Figure 3: Fused FDG-PET–CT scans in a patient with metastatic prostate cancer.

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Acknowledgements

This work was supported by the National Institutes of Health (National Cancer Institute Grant R01-CA111613).

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    Hossein Jadvar

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Jadvar, H. Molecular imaging of prostate cancer with 18F-fluorodeoxyglucose PET. Nat Rev Urol 6, 317–323 (2009). https://doi.org/10.1038/nrurol.2009.81

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