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Prostate Cancer: Role of Conventional Radionuclide and Hybrid Bone Imaging

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Radionuclide and Hybrid Bone Imaging

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Abstract

Bone is the second most common site of metastatic disease after lymph nodes in prostate cancer. This is related to a poor prognosis and is one of the major causes of morbidity and mortality in patients with prostate carcinoma. Early detection of osseous metastases and the definition of its extent, pattern and aggressiveness are crucial for proper staging and restaging; it is particularly important in high-risk primary disease before embarking on radical prostatectomy or radiation therapy.

Different patterns of bone metastases, such as early bone marrow infiltration, osteoblastic, osteolytic and mixed changes, can be seen. These types of metastases differ in their effect on bone, and consequently the choice of imaging modalities that best depict the lesions may vary. Over the last decades, bone scintigraphy has been used routinely in the evaluation of prostate cancer patients. Despite of its acceptable sensitivity, bone scintigraphy has low specificity in differentiation of the malignant versus benign lesions. Single-photon emission tomography (SPECT) increases the sensitivity and specificity of planar bone scanning, especially for the evaluation of the spine. Positron emission tomography (PET) is increasing in popularity for staging newly diagnosed prostate cancer and for assessing response to therapy. Many PET tracers have been examined for the evaluation of prostate cancer patients based on increased glycolysis (F-18 FDG), cell membrane proliferation by radiolabelled phospholipids (C-11 and F-18 choline), fatty acid synthesis (C-11 acetate), amino acid transport and protein synthesis (C-11 methionine), androgen receptor expression (F-18 FDHT) and osteoblastic activity (F-18 fluoride). However, there are presently no accurate imaging modalities to directly, reproducibly and effectively delineate bone metastases in prostate cancer.

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Abbreviations

Acetate:

C-11 acetate

BM:

Bone metastases

BS:

Bone scintigraphy

CIM:

Conventional imaging modalities

CT:

Computed tomography

DHT:

Dihydrotestosterone

FCH:

F-18 methylcholine

FDG:

F-18 fluorodeoxyglucose

Flouride:

F-18 fluoride

HT:

Hormone therapy

HU:

Hounsfield unit

MDP:

Tc-99m methylene diphosphonate

PET:

Positron emission tomography

PSA:

Prostate-specific antigen

PSMA:

Prostate-specific membrane antigen

SPECT:

Single-photon emission computed tomography

SUV:

Standardised uptake value

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  1. Department of Nuclear Medicine and Endocrinology, PET–CT Center Linz, St Vincent’s Hospital, Seilerstaette 4, Linz, A – 4020, Austria

    Mohsen Beheshti M.D., FEBNM, FASNC & Werner Langsteger M.D., FACE

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  1. Mohsen Beheshti M.D., FEBNM, FASNC
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  2. Werner Langsteger M.D., FACE
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Correspondence to Mohsen Beheshti M.D., FEBNM, FASNC .

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  1. School of Medicine, Dept. Nuclear Medicine, Guy's, King's and St. Thomas', Guy's Campus, London, SE1 9RT, United Kingdom

    Ignac Fogelman

  2. Deptartment of Nuclear Medicine, Guy's and St. Thomas Hospital, St. Thomas Street, London, SE1 9RT, United Kingdom

    Gopinath Gnanasegaran

  3. Dept. Nuclear Medicine &, Nuclear Cardiology, Concord Repatriation General Hospital, Hospital Road, Concord West, 2138, New South Wales, Australia

    Hans van der Wall

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Beheshti, M., Langsteger, W. (2012). Prostate Cancer: Role of Conventional Radionuclide and Hybrid Bone Imaging. In: Fogelman, I., Gnanasegaran, G., van der Wall, H. (eds) Radionuclide and Hybrid Bone Imaging. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02400-9_25

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