PET-CT for treatment planning in prostate cancer

Molecular imaging techniques, such as positron emission tomography (PET), may be of help in management treatment planning. In particular, in prostate cancer patients, PET and PET-computed tomography (PET-CT) can be successfully used in treatment planning at different steps, including: 1) tumor characterization and staging, to define the most appropriate primary treatment; 2) re-staging, to define a second line therapy on the site of possible recurrences; and 3) monitoring the disease and the efficacy of treatment. Although the most commonly used PET tracer, [(18)F]Fluorodeoxyglucose ([(18)F]FDG), presents limitations in imaging prostate cancer patients, several alternative PET tracers have been proposed to evaluate by PET these patients, with promising RESULTS: Optimal treatment for prostate cancer depends on the accuracy in tumor characterization and staging. In fact, localized primary tumor can be treated with radical prostatectomy, while metastatic tumor is usually treated with systemic therapeutic regimen. Different PET tracers, including [(11)C]Choline, [(18)F]Choline and [(11)C]Acetate, have been successfully reported. Howe-ver, further studies in large population of patients are still necessary to establish their final clinical role in the primary detection and staging of prostate cancer. The information on the site of possible recurrences is also important for therapeutic strategies. Several PET tracers have been proposed to re-stage prostate cancer patients. In particular, [11C]Choline PET has now been established as a clinical procedure to non-invasively re-stage, in a single session, prostate cancer patients presenting an increase of prostate specific antigen (PSA) after radical treatment. The role of PET and PET-CT in monitoring the disease and the effects of treatment are under investigation and still to be defined. In the present review, we focused on the use of several PET tracers in different clinical indications aimed at the treatment planning of prostate cancer patients.