Prognostic Utility of PET in Prostate Cancer

Abstract

Accurate prediction and assessment of relevant outcomes is important in clinical trial design and in clinical practice for selecting and sequencing appropriate individualized management of patients with prostate cancer. There have been many standard non-imaging based prediction tools for the various phases of prostate cancer. However these tools may be limited in individual cases and need updating based on the improved understanding of the underlying complex biology of the disease and the emergence of the novel targeted molecular imaging methods. A new platform of automated predictive tools that combine the independent molecular, imaging, and clinical information can contribute significantly to patient care and improve outcome. Such platform will also be of interest to regulatory agencies and payers as more emphasis is placed on supporting those interventions that have quantifiable and significant beneficial impact on patient outcome.

Is There Use for FDG-PET in Prostate Cancer?

“…Relevant outcome measures in prostate cancer may include, but are not limited to, time to biochemical recurrence (time to PSA progression), time to first metastasis, time to symptomatic progression, time to initiation of cytotoxic chemotherapy, time to radiographic progression, time to castrate resistance state, progression-free survival (PFS), metastasis-free survival, disease-specific survival, and overall survival (33). One study of 42 men with primary prostate cancer showed that patients with higher primary tumor FDG uptake had significantly poorer prognosis compared to those patients with tumors that showed lower FDG uptake (34).…”

PET of Glucose Metabolism and Cellular Proliferation in Prostate Cancer

“…In the clinical setting of prostate cancer, these outcome measures may include, but are not limited to, time to biochemical recurrence (time to PSA progression), time to first metastasis, time to symptomatic progression, time to initiation of cytotoxic chemotherapy, time to radiographic progression, time to castration resistance state, progression-free survival, metastasis-free survival, disease-specific survival, and overall survival (29).…”

Increased Prostate Cancer Glucose Metabolism Detected by 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Localised Gleason 8–10 Prostate Cancers Identifies Very High–risk Patients for Early Recurrence and Resistance to Castration

“…In recent years, molecular imaging with positron emission tomography coupled with computed tomography (PET/ CT) has been developed to stage cancers [14]. One of the most commonly used PET tracers is 18 F-fluorodeoxyglucose (FDG), which is preferentially taken up by malignant cells due to increased glucose metabolism known as the "Warburg effect" [15].…”