SUO 2017: Advanced Imaging in Prostate Cancer: PET/MRI of Prostate Cancer

Washington, DC (UroToday.com) In this session, Dr. Ippolito discussed the frontier of PET/MRI and its potential use in evaluation of patients with prostate cancer. While PET has poor anatomic detail and special resolution it has excellent sensitivity and molecular imaging to identify recurrence or metastasis and ensure accurate diagnostics. Conversely, MRI provides excellent anatomic detail and special resolution with poor sensitivity and average molecular imaging with less radiation exposure than CT. Combining PET with MRI provides radiographic synergy.

In addition to these advantages, PET/MRI is superior to PET/CT for soft tissue or lymph node lesions. However, CT has the benefits of being faster, improved bone evaluation, and is about 25% of the cost.

64Cu-ATSM PET/MRI was initially developed to image hypoxia, where the agent was trapped in hypoxic cells. This demonstrated efficiency in predicting outcomes in several solid tumors including cancers of the head and neck, lung, rectum and cervix. 64Cu-ATSM uptake has been correlated with MRI features of clinically significant disease on both T2 and diffusion weighted MR imaging. Additionally, the potential benefit of less transitional zone but more seminal vesical, bladder (but not lumenal), or nodal uptake has been noted. ATSM signal uniformity compared to mpMRI has been seen in areas of extracapsular extension.

The expanding selection of prostate cancer radiotracer pharmaceuticals may be overwhelming, but selecting the optimal tracer may have potential benefit for evaluation of tumor burden with treatment implications.

Presented by: Joseph Ippolito, MD, PhD, Washington University School of Medicine in St. Louis

Written by: David B. Cahn, DO, MBS, @dbcahn, Fox Chase Cancer Center, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC
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