Planning of external beam radiotherapy for prostate cancer guided by PET/CT - Beyond the Abstract

Conventional imaging of prostate cancer includes ultrasound examinations of the prostate and bone scans. These imaging methods have many shortcomings. Radiolabelled choline PET/CT scan is widely used in Europe for patients with a PSA-recurrence.

The scan may identify the site of the recurrence and help urologist to decide whether the patients have a loco-regional recurrence or a recurrence in distant organs. In a previous systematic review and meta-analysis we found that the choline PET/CT scan was better than a bone scan to detect to site for the recurrence (1). Therefore this new review reported outcome with use of non-choline tracers for the PET/CT scans and their role to guide radiotherapy of loco-regional prostate cancer (2). We found that both 11C-Acetate and 18F-FACBC were useful tracers as alternatives to radiolabelled choline. In addition recent studies found promising results with a PSMA-ligand tracer (3). This new tracer gave PET/CT possibility to detect the site of recurrence for more than half of the patients with a PSA recurrence in the range of 0.2 to 1.0 ng/ml. Therefore the new tracer is more sensitive for detection of recurrent prostate cancer than PET/CT with radiolabelled choline. Functional imaging has an increasing role for the management of patients with a PSA-recurrence. Functional imaging may help to diagnose a relevant target and optimize treatment. Conventional radiotherapy for patients with PSA-recurrent prostate cancer without use of functional imaging may imply a unnecessary risk for treatment of irrelevant sites.

Written by:
Finn Edler von Eyben, Timo Kiljunen, Aki Kangasmaki, Kalevi Kairemo, Timo Joensuu
Center of Tobacco Control Research, Birkevej 17, DK-5230 Odense M, Denmark. 

*The author welcomes collaboration with interested institutions. Email Dr. von Eyben via the link above for more information.

1. von Eyben FE, Kairemo K. Meta-analysis of (11)C-choline and (18)F-choline PET/CT for management of patients with prostate cancer. Nucl Med Commun. 2014;35:221-30.
2. von Eyben FE, Kairemo K, Kiljunen T, Joensuu T. Planning of External Beam Radiotherapy for Prostate Cancer Guided by PET/CT. Curr Radiopharm. 2015;8:19-31.
3. Afshar-Oromieh A, Avtzi E, Giesel FL, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42:197-209.

Abstract: Planning of External Beam Radiotherapy for Prostate Cancer Guided by PET/CT