Combined (18)F-FDG and (11)C-methionine PET scans in patients with newly progressive metastatic prostate cancer Journal Article

  


Authors: Nunez, R.; Macapinlac, H. A.; Yeung, H. W. D.; Akhurst, T.; Cai, S. D.; Osman, I.; Gonen, M.; Riedel, E.; Scher, H. I.; Larson, S. M.
Article Title: Combined (18)F-FDG and (11)C-methionine PET scans in patients with newly progressive metastatic prostate cancer
Abstract: Metastatic prostate cancer may respond initially to hormone suppression, with involution of tumor sites, but ultimate tumor progression is inevitable. Our aim was to detect the proportion of bone and soft-tissue lesions that represent metabolically active tumor sites in patients with progressive metastatic prostate cancer. Methods: In a prospective study, we compared F-18-FDG and L-methyl-C-11-methionine (C-11-methionine) PET with conventional imaging modalities (CIM), which included the combination of Tc-99m-methylene diphosphonate scintigraphy, CT, or MRI. Twelve patients with prostate cancer, increasing levels of prostate-specific antigen (PSA), and at least 1 site (index lesion) with new or increasing disease on CIM were studied. The total numbers of soft-tissue and bone-tissue lesions, in a site-by-site comparison, were calculated for all imaging modalities. Results: The sensitivities of F-18-FDG PET and C-11-methionine PET were 48% (167/348 lesions) and 72.1% (251/348 lesions), respectively, with CIM being used as the 100% reference (348/348). C-11-Methionine PET identified significantly more lesions than F-18-FDG PET (P < 0.01). All 12 patients with progressive metastatic prostate cancer had at least 1 lesion site of active metabolism for F-18-FDG or C-11-methionine, which could be used as an index lesion to monitor the metabolic response to therapy. A significant proportion of lesions (26%) had no detectable metabolism of F-18-FDG or C-11-methionine. Although technical factors cannot be totally excluded, we believe that metabolically inactive sites may be necrotic or dormant. More than 95% (251/258) of metabolically active sites (72% of the total number of lesions detected by CIM) metabolize C-11-methionine. F-18-FDG uptake is more variable, with 65% of metabolically active sites (48% of the total number of lesions detected by CIM). Conclusion: These findings reflect the different biologic characteristics of the lesions in a heterogeneous tumor such as prostate cancer and suggest that a time-dependent metabolic cascade may occur in advanced prostate cancer, with initial uptake of C-11-methionine in dormant sites followed by increased uptake of F-18-FDG during progression of disease.
Keywords: prostate cancer; carcinoma; radical prostatectomy; pet; nomogram; fluorodeoxyglucose; positron-emission-tomography; disease recurrence; f-18-fdg; bone scan; fluorine-18-fluorodeoxyglucose; c-11-methionine; carbon-11-methionine
Journal Title: Journal of Nuclear Medicine
Volume: 43
Issue: 1
ISSN: 0161-5505
Publisher: Society of Nuclear Medicine  
Date Published: 2002-01-01
Start Page: 46
End Page: 55
Language: English
ACCESSION: WOS:000173430600020
PROVIDER: wos
PUBMED: 11801702
Notes: Article -- Source: Wos
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MSK Authors
  1. Elyn Renee Stubblefield
    203 Stubblefield
  2. Rodolfo F Nunez
    15 Nunez
  3. Henry W D Yeung
    126 Yeung
  4. Mithat Gonen
    1028 Gonen
  5. Iman Osman
    36 Osman
  6. Homer Macapinlac
    106 Macapinlac
  7. Timothy J Akhurst
    139 Akhurst
  8. Shangde Cai
    42 Cai
  9. Steven M Larson
    958 Larson
  10. Howard Scher
    1130 Scher
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