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Molecular Imaging of Prostate Cancer

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Prostate MRI Essentials

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Abstract

Molecular imaging with positron emission tomography (PET) has been increasingly taken into consideration in prostate cancer as this noninvasive imaging method targets certain biological aspects of tumors. PET is often merged with computed tomography (CT) or magnetic resonance imaging (MRI) for better anatomical localization. There are several different radiotracers with different value in the setting of primary diagnosis, staging, and biochemical recurrence (BCR) of prostate cancer (PCa).

18FDG PET/CT has a limited use for PCa with a higher sensitivity in localizing metastases than detection of primary PCa tumors and BCR. Use of 11C-Acetate PET/CT is not justified for primary prostate cancer detection over conventional imaging methods such as mpMRI. 11C-Acetate might be useful as an indicator of tumor aggressiveness in patients with BCR. Utility of 11C- or 18F-choline PET/CT for detection of primary PCa or nodal staging is not justified. Food and Drug Administration (FDA) approved 11C-choline PET/CT for evaluation of BCR; however, it has unsatisfactory sensitivity at low PSA levels (~0.5 ng/mL). 18F-FACBC has shown a poor performance in detection of primary PCa. FDA approved 18F-flucicloclocine for evaluation of BCR; however, despite showing high sensitivity, it has the disadvantage of having a high false-positive rate.

Prostate-specific membrane antigen (PSMA) is a transmembrane protein highly upregulated in prostate cancer and weakly expressed in normal prostate tissue. PSMA expression is correlated with both grade and stage of the lesions representing disease aggressiveness. 68Ga-PSMA-11 PET/CT has demonstrated the highest value for BCR compared to other imaging methods even at low PSA levels. In addition, 68Ga-PSMA-11 PET/MR showed higher diagnostic performance in detection of primary PCa compared to mpMRI and PET alone. 18F-labeled PSMA agents (18F-DCFBC, 18F-DCFPyL, and 18F-PSMA-1007) have a longer half-life, better image resolution, improved lesion detection rate, and higher mean tumor-to-background ratio compared to 68Ga-PSMA tracers. 18F-PSMA-1007 has the advantage of hepatobiliary excretion, which can be useful in initial staging and evaluation of intraprostatic and locally recurrent PCa compared to other PSMA agents that are excreted via urinary tract.

18F-NaF PET/CT has the clinical utility in evaluation of bone metastasis in high-risk PCa patients, who have equivocal or negative findings on 99mTc bone scintigraphy.

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Authors and Affiliations

  1. NIH, Clinical Center, Radiology and Imaging Sciences, Bethesda, MD, USA

    Moozhan Nikpanah

  2. NCI, NIH, Molecular Imaging Program, Bethesda, MD, USA

    Esther Mena, Peter L. Choyke & Baris Turkbey

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  1. Moozhan Nikpanah
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  2. Esther Mena
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  4. Baris Turkbey
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Correspondence to Baris Turkbey .

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  1. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA

    Temel Tirkes

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Nikpanah, M., Mena, E., Choyke, P.L., Turkbey, B. (2020). Molecular Imaging of Prostate Cancer. In: Tirkes, T. (eds) Prostate MRI Essentials. Springer, Cham. https://doi.org/10.1007/978-3-030-45935-2_13

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