Role of nuclear medicine methods in prostate cancer management

Abstract

There is limited role of nuclear medicine in imaging of primary prostate cancer – the only method used more frequent is bone scan for staging of disease. Situation is different in the case of prostate cancer recurrence. Radiological methods are often inadequate for visualization of changes, despite to biochemical markers of recurrence. SPECT-CT Indium 111In-capromab pendetide (ProstaScint®), is a radiolabeled monoclonal antibody to prostate-specific membrane antigen, which offers a potential means of localizing sites of soft tissue metastasis in prostate cancer patients. PET-CT and PET MRI 1. 11C choline, 18F fluorocholine – Choline is an essential component of phospholipids in the cell membrane. Increase in cell proliferation and the enzyme activity is associated with an increase in choline uptake. 2. 11C acetate – is quickly and selectively taken up by PCa tumour cells located in the gland, prostate bed, lymph nodes or distant organs. 3. PMSA – 68Ga-PSMA - in PSA levels as low as ⩽0.5 ng/ml, 68Ga-PSMA PET/CT is able to show pathological accumulation outside the prostate bed. Both primary and metastatic prostate carcinomas show rapid uptake of 68Ga PSMA. 4. 68Ga-PSMA PET/CT can detect PC relapses and metastases with significantly improved contrast when compared to choline-based PET/CT, especially at low PSA levels. 5. 68Ga-PSMA PET/MRI – The novel technology shows similar accuracy and reliability in the depiction of LN and metastases to PET/CT. Because MRI is the method of choice for the assessment of the prostate gland and its combination with 68Ga-PSMA seems highly promising.