MOLECULAR IMAGING NEWS August 2016 Phoenix Molecular Imaging Carbon 11 Acetate PET CT Imaging for Prostate Cancer The treatment landscape for prostate cancer has been revolutionized by the arrival of multiple novel treatment approaches and agents over the last few years After initial treatment with surgery or radiation however up to 40 of patients will experience PSA relapse Knowing the location of a cancer recurrence is important since recurrence in the prostate bed or pelvic lymph nodes may be amenable to additional focal therapy Finding lesions outside of the pelvis distant metastases may require systemic treatment with hormones combined with radiation or other focal treatment The primary difficulty in this situation is that standard imaging techniques such as technetium bone scan CT scans and MRI are usually unable to see small recurrent tumors or metastases On the other hand PET scans that work by exploiting various aspects of cancer metabolism can often visualize and locate these small tumors Carbon 11 C11 Acetate PET CT is an imaging technique that has been shown to be very useful in patients with prostate cancer In prostate cancer there is an increase in fatty acid metabolism which is due in part to the up regulation of intracellular fatty acid synthase C11 Acetate is able to visualize this metabolic process and can thereby detect and localize recurrent prostate cancer and prostate cancer metastases Lymph node lesions as small as 4 5 mm can be identified by this technique Phoenix Molecular Imaging and C11 Acetate A open access clinical trial study evaluating C11 Acetate PET CT has been conducted by Phoenix Molecular Imaging under the direction of Fabio Almeida MD In this study over 1000 patients with recurrent prostate cancer as evidenced by a rising PSA have been studied using a high resolution PET CT camera The study has demonstrated an overall detection rate of 88 The PSA level is being shown to have an influence on the detection rate When the PSA is 1 0 ng mL the detection rate is 90 With a PSA of 0 2 1 0 ng mL the detection rate is 74 The doubling time or rate of PSA rise also appears to have an influence such that when the PSA is
MOLECULAR IMAGING NEWS August 2016  Phoenix Molecular Imaging  Carbon-11 Acetate PET CT Imaging for Prostate Cancer The tr...
Case Example 2 Mr S is 69 years old and was diagnosed with PCa in 2010 His Gleason score was 8 4 4 and his PSA was 4 8ng mL He underwent a prostatectomy at which time extracapsular extension was found After surgery his PSA was initially undetectable but it began to rise a few months later and within a year his PSA had risen to 0 5 ng mL with a doubling rate of 3 18 months C11 Acetate uptake in the prostate bed Case Example 1 Mr V is 76 years old and was diagnosed with Prostate Adenocarcinoma PCa in 2000 His Gleason score was 8 4 4 and his PSA was 4 0 He underwent a prostatectomy in 2001 and his PSA remained
Case Example 2 Mr. S is 69 years old and was diagnosed with PCa in 2010. His Gleason score was 8  4 4  and his PSA was 4.8...
C11 Acetate appears superior to C11 F18 Choline The overall detection rate for cancer recurrence or metastatic disease with C11 Acetate is 88 which compares to 74 for C11 Choline as reported by Mitchell et al J Urol 189 4 1308 1313 Lesion detect at lower PSA levels
C11-Acetate appears superior to C11 F18 Choline The overall detection rate for cancer recurrence or metastatic disease wit...
Case Example 4 Contact Us Mr SE is 74 years old and was diagnosed with PCa in 2003 His Gleason score was 6 3 3 and his PSA was 10 4 ng mL He underwent a high dose brachytherapy to the prostate HDR In 2008 his PSA began to rise and a Combidex study showed involvement of left pelvic lymph nodes He had IMRT radiation to the lymph nodes but his PSA did not respond He was treated with Cytoxan Luekine and Metformin His PSA continued to rise A CT scan in 2013 showed no evidence of metastatic disease By 2015 his PSA had risen to 7 46 ng mL with a doubling rate of 7 9 months A C11 Acetate PET CT imaging study was performed which showed diffusely increased metabolism in the bone associated with innumerable tiny areas of scarring sclerosis yellow arrows on image to the right This was indicative of diffuse bone metastasis Based on the C11 Acetate imaging study Mr SE underwent a bone biopsy which confirmed the presence of bone metastasis He was started on systemic treatment with hormone therapy Give us a call for more information about C11Acetate PET CT Imaging Phoenix Molecular Imaging 4540 E Cotton Gin Loop Suite 150 Phoenix AZ 85040 602 368 3055 Visit us on the web at www phxmi com C11 Acetate uptake in the bones C11 Acetate guided Treatment Response In our study salvage radiation treatment to the lesions identified by C11 Acetate was performed either alone or conjunction with hormone therapy in a large number of patients 40 Follow up of these patients to assess the duration of PSA response is ongoing Thus far in those treated with radiation treatment alone 50 have shown a persistent drop in PSA for at east 1 year In those patients for which greater than 3 years of follow up is available 29 continue to have a durable PSA response to treatment and have not yet required additional treatment These results are very encouraging An even larger number of durable PSA responses will be expected in those who receive C11 Acetate guided radiation treatment and also at least a short course of hormone therapy Summary C11 Acetate PET CT imaging appears highly useful in men with recurrent prostate cancer It has a high detection rate even at low PSA levels and in many cases identifies areas of recurrent or regionally metastatic disease that can be treated with radiation or other focal therapy Treatment with hormone therapy may be avoided or significantly delayed In other cases C11 Acetate may show evidence of distant metastatic disease not seen by other techniques thereby helping to better identify situations where systemic hormone therapy is the most appropriate course of action
Case Example 4  Contact Us  Mr. SE is 74 years old and was diagnosed with PCa in 2003. His Gleason score was 6  3 3  and h...