Multimodale molekulare Bildgebung des Prostatakarzinoms – aktueller Stand

Zusammenfassung

Das Prostatakarzinom ist die häufigste lebensbedrohliche Tumorerkrankung des Mannes in der westlichen Hemisphäre. In Deutschland muss mit ca. 40 600 Erkrankungen jährlich gerechnet werden. Die Mortalität liegt bei ca. 10% der Erkrankten. Ziel der prätherapeutischen Diagnostik ist die möglichst exakte Bestimmung des lokalen Ausmaßes des Prostatakarzinoms bezüglich intraprostatischer Lokalisationen, Kapseldurchbruch, Samenblaseninfiltration, Infiltration der neurovaskulären Bündel und gegebenenfalls der umgebenden Organe des kleinen Beckens, die Detektion einer lokoregionären Lymphknotenmetastasierung und gegebenenfalls einer Fernmetastasierung. Eine exakte prätherapeutische Diagnostik ist deshalb wichtig, weil die verfügbaren Behandlungsstrategien in strenger Abhängigkeit vom festgestellten klinischen Stadium der Tumorerkrankung und Risikoprofil festgelegt werden müssen. Die anatomische und funktionelle molekulare Bildgebung des Prostatakarzinoms hat in den letzten Jahren erhebliche Fortschritte erzielt. Insbesondere in diagnostischen Problemfällen, z. B. bei negativer Stanzbiopsie und persistierendem Verdacht auf ein Prostatakarzinom, können die ¹¹C-/¹⁸F-Cholin PET/CT-Bildgebung und die MRT/MRS des Prostatakarzinoms häufig das Karzinom lokalisieren, die Beziehung zu den umgebenden intra- und extraprostatischen Strukturen und Organen darstellen und die eine gezielte Rebiopsie ermöglichen. Das nodale Staging des Prostatakarzinoms ist mit konventioneller Bildgebung ohne spezifische, derzeit klinisch noch nicht verfügbare lymphotrope Kontrastmittel schwierig. Besondere Fortschritte wurden in der Bildgebung des Lokalrezidivs erzielt, da dies auch schon bei deutlich <1 ng/ml PSA-Werten häufig lokalisiert werden kann. Bei dieser Fragestellung hat sich nach unseren Erfahrungen besonders die Kombination von ¹¹C-Cholin-PET/CT mit Kontrastmittel gestützter MRT bewährt. Für die Diagnostik von Skelettmetastasen hat sich ¹⁸F-Natriumfluorid-PET/CT als hoch aussagekräftig erwiesen.

Abstract

Prostate carcinoma is the most common life-threatening cancer affecting men in the western world. In Germany about 40 600 new cases have to be expected each year. The mortality is around 10%. The major goals of pretherapeutic imaging are to determine the local extent of prostate carcinoma in terms of intraprostate localisation, extracapsular extension (ECE), seminal vesicle invasion (SVI), tumour infiltration into neurovascular bundles, and if this has taken place, into surrounding tissues and organs in the small pelvis, detection of loco-regional metastases via the lymph nodes and if this so, of distant metastases. Exact pretherapeutic diagnosis and staging are essential, because the tumour treatment must be selected in strict dependence on clinical tumour stage and risk profile. Both anatomic and functional molecular imaging of prostate carcinoma have advanced significantly in recent years. When there are problems with diagnosis, e.g. when prostate punch biopsies are negative while the suspicion of prostate carcinoma persists, C-11/F-18 choline PET/CT and MRI/MRS may be helpful in localising the carcinoma, revealing how the carcinoma relates to the surrounding intra- and extraprostatic structures and organs, and making a targeted repeat biopsy possible. Lymphotropic contrast agents are highly promising for accurate nodal staging of prostate carcinoma, but are not yet available for routine clinical use. In these circumstances, the sensitivity of nodal staging with the widely available imaging modalities remains difficult. There has been particularly substantial progress in the localisation of local relapse, which can be imaged with contrast-enhanced C-11-choline PET/CT and MRI in most cases when PSA is considerably below 1 ng/ml. F-18-fluoride PET/CT has proved accurate in the diagnosis of skeletal metastases from prostate carcinoma.

Schlüsselwörter

Prostatakarzinom - Lokalrezidiv - ¹¹C-Cholin-PET/CT - molekulare Bildgebung - bildgebende Diagnostik

Key words

prostate carcinoma - local relapse - C-11-choline PET/CT - molecular imaging - MRI

Literatur

• 1 Albrecht S, Buchegger F, Soloviev D. et al . ¹¹C-acetate PET in the early evaluation of prostate cancer recurrence.  Eur J Nucl Med Mol Imaging. 2007;  34 185-196
• 2 Boccon-Gibod L, Djavan WB, Hammerer P. et al . Management of prostate-specific antigen relapse in prostate cancer: a European Consensus.  Int J Clin Pract. 2004;  58 382-390
• 3 Bott SR. Management of recurrent disease after radical prostatectomy.  Prostate Cancer Prostatic Dis. 2004;  7 211-216
• 4 Carroll PR, Coakley FV, Kurhanewicz J. Magnetic resonance imaging and spectroscopy of prostate cancer.  Rev Urol. 2006;  8 4-10
• 5 Cimitan M, Bortolus R, Morassut S. et al . ¹⁸F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients.  Eur J Nucl Med Mol Imaging. 2006;  33 1387-1398
• 6 de Jong I, Pruim J, Elsinga P. et al . Visualization of Prostate Cancer with ¹¹C-Choline Positron Emission Tomography.  Eur Urol. 2002;  42 18-23
• 7 de Jong IJ, Pruim J, Elsinga PH. et al . Preoperative staging of pelvic lymph nodes in prostate cancer by ¹¹C-choline PET.  J Nucl Med. 2003;  44 331-335
• 8 DeGrado TR, Coleman RE, Wang S. et al . Synthesis and evaluation of ¹⁸F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer.  Cancer Res. 2001;  61 110-117
• 9 Effert PJ, Bares R, Handt S. et al . Metabolic imaging of untreated prostate cancer by positron emission tomography with ¹⁸fluorine-labeled deoxyglucose.  J Urol. 1996;  155 994-998
• 10 Even-Sapir E, Metser U, Mishani E. et al . The Detection of Bone Metastases in Patients with High-Risk Prostate Cancer: ^99 mTc-MDP Planar Bone Scintigraphy, Single- and Multi-Field-of-View SPECT, ¹⁸F-Fluoride PET, and ¹⁸F-Fluoride PET/CT.  J Nucl Med. 2006;  47 287-297
• 11 Farsad M, Schiavina R, Castellucci P. et al . Detection and Localization of Prostate Cancer: Correlation of ¹¹C-Choline PET/CT with Histopathologic Step-Section Analysis.  J Nucl Med. 2005;  46 1642-1649
• 12 Hara T, Kosaka N, Kishi H. PET imaging of prostate cancer using carbon-11-choline.  J Nucl Med. 1998;  39 990-995
• 13 Harisinghani MG, Barentsz J, Hahn PF. et al . Noninvasive detection of clinically occult lymph-node metastases in prostate cancer.  N Engl J Med. 2003;  348 2491-2499
• 14 Harisinghani MG, Dixon WT, Saksena MA. et al . MR lymphangiography: imaging strategies to optimize the imaging of lymph nodes with ferumoxtran-10.  Radiographics. 2004;  24 867-878
• 15 Heerschap A, Jager GJ, van der Graaf M. In vivo proton MR spectroscopy reveals altered metabolite content in malignant prostate tissue.  Anticancer Res. 1997;  17 1455-1460
• 16 Heinisch M, Dirisamer A, Loidl W. et al . Positron emission tomography/computed tomography with F-18-fluorocholine for restaging of prostate cancer patients: meaningful at PSA <5 ng/ml?.  Mol Imaging Biol. 2006;  8 43-48
• 17 Hricak H, Choyke PL, Eberhardt SC. et al . Imaging Prostate Cancer: A Multidisciplinary Perspective.  Radiology. 2007;  243 28-53
• 18 Jemal A, Murray T, Samuels A. et al . Cancer statistics, 2005.  CA Cancer J Clin. 2005;  53 5-26
• 19 Kotzerke J, Prang J, Neumaier B. et al . Experience with carbon-11 choline positron emission tomography in prostate carcinoma.  Eur J Nucl Med. 2000;  27 1415-1419
• 20 Kotzerke J, Volkmer BG, Glatting G. et al . Intraindividual comparison of [¹¹C]acetate and [¹¹C]choline PET for detection of metastases of prostate cancer.  Nuklearmedizin. 2003;  42 25-30
• 21 Kuban DA, Levy LB, Potters L. et al . Comparison of biochemical failure definitions for permanent prostate brachytherapy.  Int J Radiat Oncol Biol Phys. 2006;  65 1487-1493
• 22 Kwee SA, Wei H, Sesterhenn I. et al . Localization of Primary Prostate Cancer with Dual-Phase 18F-Fluorocholine PET.  J Nucl Med. 2006;  47 262-269
• 23 Larson SM, Morris M, Gunther I. et al . Tumor localization of 16beta-18F-fluoro-5alpha-dihydrotestosterone versus 18F-FDG in patients with progressive, metastatic prostate cancer.  J Nucl Med. 2004;  45 366-373
• 24 Morakkabati-Spitz N, Bastian PJ, Meissner A. et al . MR techniques for noninvasive diagnosis of prostate cancer].  Urologe A. 2006;  45 702-705
• 25 Nelson WG, Carter HB, DeWeese TL. et al .Prostate Cancer. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, editors. Clinical Oncology. 3rd edition ed. Philadelphia: Elsevier 2004: 2085-2148
• 26 Oyama N, Miller TR, Dehdashti F. et al . ¹¹C-Acetate PET Imaging of Prostate Cancer: Detection of Recurrent Disease at PSA Relapse.  J Nucl Med. 2003;  44 549-555
• 27 Pathak AP, Gimi B, Glunde K. et al . Molecular and functional imaging of cancer: advances in MRI and MRS.  Methods Enzymol. 2004;  386 3-60
• 28 Picchio M, Messa C, Landoni C. et al . Value of [¹¹C]choline-positron emission tomography for re-staging prostate cancer: a comparison with [¹⁸F]fluorodeoxyglucose-positron emission tomography.  J Urol. 2003;  169 1337-1340
• 29 Pound CR, Partin AW, Eisenberger MA. et al . Natural history of progression after PSA elevation following radical prostatectomy.  JAMA. 1999;  281 1591-1597
• 30 Prando A, Kurhanewicz J, Borges AP. et al . Prostatic biopsy directed with endorectal MR spectroscopic imaging findings in patients with elevated prostate specific antigen levels and prior negative biopsy findings: early experience.  Radiology. 2005;  236 903-910
• 31 Reske SN, Blumstein NM, Glatting G. PET und PET/CT in der Rezidivdiagnostik des Prostata-Karzinoms [PET and PET/CT in relapsing prostate carcinoma].  Urologe A. 2006;  45 1240-1250
• 32 Reske SN, Blumstein NM, Glatting G. Weiterentwicklung der PET und des PET/CT beim Prostatakarzinom [Advancement of PET and PET/CT in prostate carcinoma.  Urologe A. 2006;  45 707-714
• 33 Reske SN, Blumstein NM, Neumaier B. et al . Imaging Prostate Cancer with ¹¹C-Choline PET/CT.  J Nucl Med. 2006;  47 1249-1254
• 34 Schauer AJ, Becker W, Reiser M. et al . The Sentinel Lymph Node Concept. Springer Verlag 2005: 565
• 35 Scher B, Seitz M, Albinger W. et al . Value of ¹¹C-choline PET and PET/CT in patients with suspected prostate cancer.  Eur J Nucl Med Mol Imaging. 2007;  34 45-53
• 36 Schirrmeister H, Glatting G, Hetzel J. et al . Prospective evaluation of the clinical value of planar bone scans, SPECT, and ¹⁸F-labeled NaF PET in newly diagnosed lung cancer.  J Nucl Med. 2001;  42 1800-1804
• 37 Schirrmeister H, Guhlmann A, Elsner K. et al . Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus ¹⁸F PET.  J Nucl Med. 1999;  40 1623-1629
• 38 Schmid DT, John H, Zweifel R. et al . Fluorocholine PET/CT in patients with prostate cancer: initial experience.  Radiology. 2005;  235 623-628
• 39 Schuster DM, Votaw JR, Nieh PT. et al . Initial experience with the radiotracer anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid with PET/CT in prostate carcinoma.  J Nucl Med. 2007;  48 56-63
• 40 Shreve PD, Grossman HB, Gross MD. et al . Metastatic prostate cancer: initial findings of PET with 2-deoxy-2-[F-18]fluoro-D-glucose.  Radiology. 1996;  199 751-756
• 41 Sutinen E, Nurmi M, Roivainen A. et al . Kinetics of [¹¹C]choline uptake in prostate cancer: a PET study.  Eur J Nucl Med Mol Imaging. 2004;  31 317-324
• 42 Trabulsi EJ, Merriam WG, Gomella LG. New imaging techniques in prostate cancer.  Curr Urol Rep. 2006;  7 175-180
• 43 Vogt H, Wawroschek F, Wengenmair H. et al . Sentinel lymph node diagnostic in prostate carcinoma: Part I: Technique and clinical evaluation.  Nuklear Medizin. 2002;  41 95-101
• 44 Wachter S, Tomek S, Kurtaran A. et al . Clinical Impact of ¹¹C-Acetate Positron Emission Tomography Imaging and Added Value of Image Fusion With Computed Tomography and Magnetic Resonance Imaging in Patients With Recurrent Prostate Cancer.  J Clin Oncol. 2006;  24 2513-2519
• 45 Weissleder R, Elizondo G, Wittenberg J. et al . Ultrasmall superparamagnetic iron oxide: an intravenous Contrast Agent for assessing Lymph Nodes with MR Imaging.  Radiology. 1990;  175 494-498
• 46 Yamaguchi T, Lee J, Uemura H. et al . Prostate cancer: a comparative study of ¹¹C-choline PET and MR imaging combined with proton MR spectroscopy.  Eur J Nucl Med Mol Imaging. 2005;  32 742-748
• 47 Yoshida S, Nakagomi K, Goto S. et al . ¹¹C-Choline Positron Emission Tomography in Prostate Cancer: Primary Staging and Recurrent Site Staging.  Urol lnt. 2005;  74 214-220

Korrespondenzadresse