Does Computed Tomography or Positron Emission Tomography/Computed Tomography Contribute to Detection of Small Focal Cancers in the Prostate?

Abstract

Prostate cancer is considered to be a multifocal tumor in the majority of patients. Based on histologic data after prostatectomy, there is a growing insight that a considerable number of men who receive a diagnosis in the contemporary setting of prostate-specific antigen screening have unilateral or unifocal disease. With this, the current concept of whole-gland therapy has come into discussion. The need for improvement of intraprostatic tumor characterization is clear. Molecular imaging is one of the areas of research on this aspect. The clinical indications for positron emission tomography (PET)/CT have increased rapidly in the field of oncology and are largely based on fluorodeoxyglucose (FDG) PET. Both conventional CT and FDG PET, however, cannot detect prostate cancer foci <5 mm within the prostate. Dynamic contrast-enhanced CT involves imaging a region of interest rapidly (usually <10 seconds between images) during a bolus intravenous injection of a contrast agent. Through analysis of the contrast enhancement time curves, it is possible to distinguish tissues with different microvascular properties such as cancer. The technologic aspects of both imaging techniques and the clinical results of 11C-choline PET/CT for intraprostatic tumor characterization are discussed. Based on preliminary studies, dynamic contrast-enhanced (DCE)-CT may be a useful tool for localization of prostate tumors and, perhaps more importantly, quantification of therapeutic response in prostate cancer. Validation work is necessary, however, to define its accuracy and role in therapeutic paradigms such as focal therapies, particularly given the current accuracy of MRI. In the future, combining DCE-CT with CT or (11)C-choline PET/CT may be an alternative to MRI, offering a combination of quantitative parameters that may correlate to tumor prognosis as well as cancer localization for focal therapy.

The future of imaging: developing the tools for monitoring response to therapy in oncology: the 2009 Sir James MacKenzie Davidson Memorial lecture

“…Furthermore, the diagnostic sensitivity should be improved through increased availability of substrate for tumour uptake. Future studies in humans will determine the clinical value of this new radiotracer in imaging prostate cancer, where [ 11 C]choline has been shown to have value [35][36][37], and for other indications where [ 11 C]choline uptake or choline kinase expression is altered, including breast [38,39], ovarian [40] and lung cancer [41].…”