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PET und PET/CT in der Rezidivdiagnostik des Prostatakarzinoms

PET and PET/CT in relapsing prostate carcinoma

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Zusammenfassung

17–53% der in kurativer Intention behandelten Patienten mit Prostatakarzinom erleiden ein biochemisches Rezidiv und 16–35% werden einer Second-line-Salvagetherapie innerhalb von 5 Jahren nach Rezidivmanifestation zugeführt werden müssen. In ca. 50% liegt ein isoliertes Lokalrezidiv und in 50% eine metastasierte Erkrankung mit oder ohne Lokalrezidiv vor. Die Rezidivlokalisation stellt deshalb eine kritische Determinante für die Wahl lokoregionärer oder systemischer Therapiestrategien dar. Die Fusionsbildgebung mit 11C/18F-Cholin oder 11C-Acetat-PET/CT hat das diagnostische Spektrum der bildgebenden Diagnostik des rezidivierenden Prostatakarzinoms erweitert. In ca. 60–70% der Patienten mit biochemischem Rezidiv kann das Rezidiv detektiert und anatomisch präzise lokalisiert werden. Die Detektionssensitivität ist negativ mit der PSA-Serumkonzentration korreliert. Bei Werten von <1 ng/ml dürfte die mittlere Detektionssensitivität bei 50–66% liegen. Die Fusionsbildgebung mit 11C-Cholin-PET/CT und MRT birgt ein hohes Zukunftspotenzial zur frühen Lokalisationsdiagnostik des rezidivierenden Prostatakarzinoms.

Abstract

Of patients with carcinoma of the prostate undergoing therapeutic regimes with curative intent, 15–23% will ultimately relapse and 16–35% will need some sort of salvage therapy within 5 years. Of relapsing patients, 50% will have local recurrence and 50% systemic disease with or without local recurrence. Therefore, localization of recurrent prostate cancer is critical for selecting a local or systemic therapeutic strategy. Modern fusion imaging with PET/CT and 11C/18F-choline or 11C-acetate has augmented the diagnostic imaging spectrum for assessment of relapsing prostate cancer. In 60–70% of patients with biochemical relapse, recurrent tumor can be detected and anatomically precisely localized. Detection sensitivity is probably negatively correlated with serum PSA concentration. Below a PSA level of 1 ng/ml, mean detection sensitivity is probably 50–66%. Fusion imaging with 11C-choline PET/CT and MRI possesses a high potential for early localization of recurrent prostate carcinoma.

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  1. Klinik für Nuklearmedizin, Universitätsklinikum, Robert-Koch-Straße 8, 89081, Ulm, Deutschland

    S. N. Reske, N. M. Blumstein & G. Glatting

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  1. S. N. Reske
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  2. N. M. Blumstein
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  3. G. Glatting
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Correspondence to S. N. Reske.

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Reske, S.N., Blumstein, N.M. & Glatting, G. PET und PET/CT in der Rezidivdiagnostik des Prostatakarzinoms. Urologe 45, 1240–1250 (2006). https://doi.org/10.1007/s00120-006-1212-6

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  • DOI: https://doi.org/10.1007/s00120-006-1212-6

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