Mattijs Elschot1, Kirsten M Selnæs2,3, Elise Sandsmark2, Brage Krüger-Stokke2,4, Øystein Størkersen5, May-Britt Tessem2, Siver A Moestue2,6, Helena Bertilsson7,8, Tone F Bathen2,3. 1. Deparment of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Mail MTFS*3.1313, POBox 8905, N-7491, Trondheim, Norway. mattijs.elschot@ntnu.no. 2. Deparment of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Mail MTFS*3.1313, POBox 8905, N-7491, Trondheim, Norway. 3. St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 4. Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 5. Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 6. Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. 7. Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 8. Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Abstract
PURPOSE: [18F]Fluciclovine PET imaging shows promise for the assessment of prostate cancer. The purpose of this PET/MRI study is to optimise the PET imaging protocol for detection and characterisation of primary prostate cancer, by quantitative evaluation of the dynamic uptake of [18F]Fluciclovine in cancerous and benign tissue. METHODS: Patients diagnosed with high-risk primary prostate cancer underwent an integrated [18F]Fluciclovine PET/MRI exam before robot-assisted radical prostatectomy with extended pelvic lymph node dissection. Volumes-of-interest (VOIs) of selected organs (prostate, bladder, blood pool) and sub-glandular prostate structures (tumour, benign prostatic hyperplasia (BPH), inflammation, healthy tissue) were delineated on T2-weighted MR images, using whole-mount histology samples as a reference. Three candidate windows for optimal PET imaging were identified based on the dynamic curves of the mean and maximum standardised uptake value (SUVmean and SUVmax, respectively). The statistical significance of differences in SUV between VOIs were analysed using Wilcoxon rank sum tests (p<0.05, adjusted for multiple testing). RESULTS: Twenty-eight (28) patients [median (range) age: 66 (55-72) years] were included. An early (W1: 5-10 minutes post-injection) and two late candidate windows (W2: 18-23; W3: 33-38 minutes post-injection) were selected. Late compared with early imaging was better able to distinguish between malignant and benign tissue [W3, SUVmean: tumour vs. BPH 2.5 vs. 2.0 (p<0.001), tumour vs. inflammation 2.5 vs. 1.7 (p<0.001), tumour vs. healthy tissue 2.5 vs. 2.0 (p<0.001); W1, SUVmean: tumour vs. BPH 3.1 vs. 3.1 (p=0.771), tumour vs inflammation 3.1 vs. 2.2 (p=0.021), tumour vs. healthy tissue 3.1 vs. 2.5 (p<0.001)] as well as between high-grade and low/intermediate-grade tumours (W3, SUVmean: 2.6 vs. 2.1 (p=0.040); W1, SUVmean: 3.1 vs. 2.8 (p=0.173)). These differences were relevant to the peripheral zone, but not the central gland. CONCLUSION: Late-window [18F]Fluciclovine PET imaging shows promise for distinguishing between prostate tumours and benign tissue and for assessment of tumour aggressiveness.
PURPOSE: [18F]Fluciclovine PET imaging shows promise for the assessment of prostate cancer. The purpose of this PET/MRI study is to optimise the PET imaging protocol for detection and characterisation of primary prostate cancer, by quantitative evaluation of the dynamic uptake of [18F]Fluciclovine in cancerous and benign tissue. METHODS:Patients diagnosed with high-risk primary prostate cancer underwent an integrated [18F]Fluciclovine PET/MRI exam before robot-assisted radical prostatectomy with extended pelvic lymph node dissection. Volumes-of-interest (VOIs) of selected organs (prostate, bladder, blood pool) and sub-glandular prostate structures (tumour, benign prostatic hyperplasia (BPH), inflammation, healthy tissue) were delineated on T2-weighted MR images, using whole-mount histology samples as a reference. Three candidate windows for optimal PET imaging were identified based on the dynamic curves of the mean and maximum standardised uptake value (SUVmean and SUVmax, respectively). The statistical significance of differences in SUV between VOIs were analysed using Wilcoxon rank sum tests (p<0.05, adjusted for multiple testing). RESULTS: Twenty-eight (28) patients [median (range) age: 66 (55-72) years] were included. An early (W1: 5-10 minutes post-injection) and two late candidate windows (W2: 18-23; W3: 33-38 minutes post-injection) were selected. Late compared with early imaging was better able to distinguish between malignant and benign tissue [W3, SUVmean: tumour vs. BPH 2.5 vs. 2.0 (p<0.001), tumour vs. inflammation 2.5 vs. 1.7 (p<0.001), tumour vs. healthy tissue 2.5 vs. 2.0 (p<0.001); W1, SUVmean: tumour vs. BPH 3.1 vs. 3.1 (p=0.771), tumour vs inflammation 3.1 vs. 2.2 (p=0.021), tumour vs. healthy tissue 3.1 vs. 2.5 (p<0.001)] as well as between high-grade and low/intermediate-grade tumours (W3, SUVmean: 2.6 vs. 2.1 (p=0.040); W1, SUVmean: 3.1 vs. 2.8 (p=0.173)). These differences were relevant to the peripheral zone, but not the central gland. CONCLUSION: Late-window [18F]Fluciclovine PET imaging shows promise for distinguishing between prostate tumours and benign tissue and for assessment of tumour aggressiveness.
Authors: David M Schuster; John R Votaw; Peter T Nieh; Weiping Yu; Jonathon A Nye; Viraj Master; F DuBois Bowman; Muta M Issa; Mark M Goodman Journal: J Nucl Med Date: 2007-01 Impact factor: 10.057
Authors: Stefan Klein; Marius Staring; Keelin Murphy; Max A Viergever; Josien P W Pluim Journal: IEEE Trans Med Imaging Date: 2009-11-17 Impact factor: 10.048
Authors: Lindsey A Torre; Freddie Bray; Rebecca L Siegel; Jacques Ferlay; Joannie Lortet-Tieulent; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2015-02-04 Impact factor: 508.702
Authors: Thiele Kobus; Pieter C Vos; Thomas Hambrock; Maarten De Rooij; Christina A Hulsbergen-Van de Kaa; Jelle O Barentsz; Arend Heerschap; Tom W J Scheenen Journal: Radiology Date: 2012-07-27 Impact factor: 11.105
Authors: Jelle O Barentsz; Jeffrey C Weinreb; Sadhna Verma; Harriet C Thoeny; Clare M Tempany; Faina Shtern; Anwar R Padhani; Daniel Margolis; Katarzyna J Macura; Masoom A Haider; Francois Cornud; Peter L Choyke Journal: Eur Urol Date: 2015-09-08 Impact factor: 20.096
Authors: Baris Turkbey; Esther Mena; Joanna Shih; Peter A Pinto; Maria J Merino; Maria L Lindenberg; Marcelino Bernardo; Yolanda L McKinney; Stephen Adler; Rikard Owenius; Peter L Choyke; Karen A Kurdziel Journal: Radiology Date: 2013-11-08 Impact factor: 11.105
Authors: David M Schuster; Peter T Nieh; Ashesh B Jani; Rianot Amzat; F Dubois Bowman; Raghuveer K Halkar; Viraj A Master; Jonathon A Nye; Oluwaseun A Odewole; Adeboye O Osunkoya; Bital Savir-Baruch; Pooneh Alaei-Taleghani; Mark M Goodman Journal: J Urol Date: 2013-10-19 Impact factor: 7.450
Authors: Jonathan I Epstein; Michael J Zelefsky; Daniel D Sjoberg; Joel B Nelson; Lars Egevad; Cristina Magi-Galluzzi; Andrew J Vickers; Anil V Parwani; Victor E Reuter; Samson W Fine; James A Eastham; Peter Wiklund; Misop Han; Chandana A Reddy; Jay P Ciezki; Tommy Nyberg; Eric A Klein Journal: Eur Urol Date: 2015-07-10 Impact factor: 20.096
Authors: Olayinka A Abiodun-Ojo; Akinyemi A Akintayo; Oladunni O Akin-Akintayo; Funmilayo I Tade; Peter T Nieh; Viraj A Master; Mehrdad Alemozaffar; Adeboye O Osunkoya; Mark M Goodman; Baowei Fei; David M Schuster Journal: J Nucl Med Date: 2019-04-06 Impact factor: 10.057
Authors: Morteza Esmaeili; Nassim Tayari; Tom Scheenen; Mattijs Elschot; Elise Sandsmark; Helena Bertilsson; Arend Heerschap; Kirsten M Selnæs; Tone F Bathen Journal: Front Oncol Date: 2018-11-15 Impact factor: 6.244