BERKELEY, CA (UroToday.com) - In oncology, and also in uro-oncology, personalized management of a patient’s disease is the new driving force in the modern era of medicine. This means the application of specific diagnostic and therapeutic strategies that are best suited for an individual patient affected by the particular type of tumour.
Among the different imaging tools currently available, positron emission tomography/computed tomography (PET/CT) can be used to visualize molecular alterations in the living subject, thus facilitating early diagnosis and treatment of disease. PET/CT, with FDG, and also other radiopharmaceuticals, is currently used in oncology to guide decision-making, e.g. whether a surgical approach is advisable, whether advanced therapies are feasible, or whether a systemic chemotherapy is appropriate. It can also further improve therapy tailoring by guiding radiation treatment planning.
[11C]choline PET/CT has been shown to be useful in prostate cancer patients, and, in particular, for restaging patients with biochemical failure. It has been demonstrated to be able to localize disease recurrence and thus to be of impact on patient management, guiding systemic vs local therapy, and in selecting the kind of local therapy. Also, recently, the U.S. Food and Drug Administration (FDA) announced approval of production and use of [11C]choline for PET/CT imaging in recurrent prostate cancer in the United States.
However there are some clinical scenarios, like patients with low PSA values, in which the positive detection rate of [11C]choline PET/CT is low. On the other hand, salvage therapy is likely to be more effective when the disease is confined. But the use of PET/CT for early restaging would be burdened by the high cost of many false-negative scans that healthcare systems cannot afford nowadays.
That is why we aimed to identify clinical or pathological factors that can predict [11C]choline PET/CT positive findings in patients with PSA < 1.5 ng/ml in order to allow the prudent selection of patient candidate for the [11C]choline PET/CT and thus properly allocate resources. [11C]choline PET/CT is the state-of-the-art imaging tool for prostate recurrence evaluation, allowing the standard of personalized care for the patient. So its use has to be optimized in order to be cost-effective.
Written by:
Margarita Kirienko,a and Maria Picchiob as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
aUniversity Milano-Bicocca, Milan, Italy
bInstitute for Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR); Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
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