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Neuroendocrine Prostate Cancer: FDG-PET and Targeted Molecular Imaging

Spratt, Daniel E. ; Zelefsky, Michael J. ; Fareedy, Shoaib B ; Lindgren, Sarah LU orcid and Osborne, Joseph R (2014) American Society for Radiation Oncology (ASTRO) 56th Annual Meeting p.209-209
Abstract
Purpose/Objective(s): Over 30% of advanced prostate cancers harbor a predominance of neuroendocrine prostate cancer (NEPC) differentiation. Fluorodeoxyglucose (FDG) positron emission tomography (PET) has numerous limitations in prostate adenocarcinoma (PCa-adeno), however there is no data that exists outside of isolated single person case reports to assess the utility of PET to restage and monitor patients who transform to NEPC. Herein, we report the first and only series of NEPC patients to assess the utility of FDG-PET, as well as 99mTc bone scan, 18F-DHT, and 89Zr-J591 immuno-PET.

Materials/Methods: Patients diagnosed with NEPC from 2003-2013 were queried via a prospectively... (More)
Purpose/Objective(s): Over 30% of advanced prostate cancers harbor a predominance of neuroendocrine prostate cancer (NEPC) differentiation. Fluorodeoxyglucose (FDG) positron emission tomography (PET) has numerous limitations in prostate adenocarcinoma (PCa-adeno), however there is no data that exists outside of isolated single person case reports to assess the utility of PET to restage and monitor patients who transform to NEPC. Herein, we report the first and only series of NEPC patients to assess the utility of FDG-PET, as well as 99mTc bone scan, 18F-DHT, and 89Zr-J591 immuno-PET.

Materials/Methods: Patients diagnosed with NEPC from 2003-2013 were queried via a prospectively maintained database at our institution. Inclusion criteria consisted of biopsy proven prostate cancer, chromogranin-A (CrA) levels >2x the upper limit of normal (ULN), and ≥1 FDG-PET scan after the diagnosis of NEPC. This yielded 23 patients with 118 metastatic lesions identified on FDG-PET. All patient scans were reviewed by two physicians (radiologist and radiation oncologist).

Results: The cohort was clinically high and very high risk at time of diagnosis of PCa-adeno, with 48% having metastatic disease, 35% with ≥T3 disease, and 78% with Gleason scores ≥8. Initial median pre-treatment PSA however was 11.7 ng/mL. The average time from treatment of PCa-adeno to transformation to NEPC was 4.6 years. The average initial CrA level was 8.7x the ULN. Nine percent of patients were diagnosed with NEPC histopathologically, while the remaining 91% were diagnosed via elevated CrA level. FDG-PET detected avid lesions in all patients after the diagnosis of NEPC, with a total of 118 metastatic sites being identified. Sixty percent of PET positive lesions were not identified on bone scan. Bone scan identified 51 sites of disease not seen on FDG-PET, however, 55% of these lesions were deemed to be most consistent with prior trauma and/or degenerative disease. Two patients had both FDG- and 18F-DHT PET; 23 lesions were identified on FDG-PET, while only 1 lesion was detected by 18F-DHT consistent with NEPC lacking the androgen receptor. The 89Zr-J591 was performed in one patient and detected 90% (9 of 10) of the lesions seen by FDG-PET as well as three addition lesions felt to represent metastatic disease, consistent with the presence of PSMA on both PCa-adeno and NEPC.

Conclusions: NEPC is becoming an increasingly common clinical entity and we present the first series analyzing the effectiveness of FDG-PET. FDG-PET has clinical utility in detecting lesions not appreciated by bone scan or CT alone, and should be considered a potential tool in the restaging and treatment monitoring of patients with NEPC.18F-DHT confirmed that the FDG positive lesions were, in fact, AR-negative and most likely NEPC. Last, J591 immuno-PET may have utility in both PCa and NEPC and should be further investigated. (Less)
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author
; ; ; and
publishing date
type
Contribution to conference
publication status
published
subject
pages
209 - 209
conference name
American Society for Radiation Oncology (ASTRO) 56th Annual Meeting
conference location
San Fransisco, United States
conference dates
2014-09-14 - 2014-09-17
DOI
10.1016/j.ijrobp.2014.05.772
language
English
LU publication?
no
id
ff99ef8b-8eeb-47aa-adf4-d03b51e016ee
date added to LUP
2022-12-13 20:51:44
date last changed
2022-12-14 08:45:06
@misc{ff99ef8b-8eeb-47aa-adf4-d03b51e016ee,
  abstract     = {{<b>Purpose/Objective(s):</b> Over 30% of advanced prostate cancers harbor a predominance of neuroendocrine prostate cancer (NEPC) differentiation. Fluorodeoxyglucose (FDG) positron emission tomography (PET) has numerous limitations in prostate adenocarcinoma (PCa-adeno), however there is no data that exists outside of isolated single person case reports to assess the utility of PET to restage and monitor patients who transform to NEPC. Herein, we report the first and only series of NEPC patients to assess the utility of FDG-PET, as well as <sup>99m</sup>Tc bone scan,<sup> 18</sup>F-DHT, and <sup>89</sup>Zr-J591 immuno-PET.<br/><br/><b>Materials/Methods:</b> Patients diagnosed with NEPC from 2003-2013 were queried via a prospectively maintained database at our institution. Inclusion criteria consisted of biopsy proven prostate cancer, chromogranin-A (CrA) levels &gt;2x the upper limit of normal (ULN), and ≥1 FDG-PET scan after the diagnosis of NEPC. This yielded 23 patients with 118 metastatic lesions identified on FDG-PET. All patient scans were reviewed by two physicians (radiologist and radiation oncologist).<br/><br/><b>Results:</b> The cohort was clinically high and very high risk at time of diagnosis of PCa-adeno, with 48% having metastatic disease, 35% with ≥T3 disease, and 78% with Gleason scores ≥8. Initial median pre-treatment PSA however was 11.7 ng/mL. The average time from treatment of PCa-adeno to transformation to NEPC was 4.6 years. The average initial CrA level was 8.7x the ULN. Nine percent of patients were diagnosed with NEPC histopathologically, while the remaining 91% were diagnosed via elevated CrA level. FDG-PET detected avid lesions in all patients after the diagnosis of NEPC, with a total of 118 metastatic sites being identified. Sixty percent of PET positive lesions were not identified on bone scan. Bone scan identified 51 sites of disease not seen on FDG-PET, however, 55% of these lesions were deemed to be most consistent with prior trauma and/or degenerative disease. Two patients had both FDG- and <sup>18</sup>F-DHT PET; 23 lesions were identified on FDG-PET, while only 1 lesion was detected by <sup>18</sup>F-DHT consistent with NEPC lacking the androgen receptor. The <sup>89</sup>Zr-J591 was performed in one patient and detected 90% (9 of 10) of the lesions seen by FDG-PET as well as three addition lesions felt to represent metastatic disease, consistent with the presence of PSMA on both PCa-adeno and NEPC.<br/><br/><b>Conclusions:</b> NEPC is becoming an increasingly common clinical entity and we present the first series analyzing the effectiveness of FDG-PET. FDG-PET has clinical utility in detecting lesions not appreciated by bone scan or CT alone, and should be considered a potential tool in the restaging and treatment monitoring of patients with NEPC.<sup>18</sup>F-DHT confirmed that the FDG positive lesions were, in fact, AR-negative and most likely NEPC. Last, J591 immuno-PET may have utility in both PCa and NEPC and should be further investigated.}},
  author       = {{Spratt, Daniel E. and Zelefsky, Michael J. and Fareedy, Shoaib B and Lindgren, Sarah and Osborne, Joseph R}},
  language     = {{eng}},
  month        = {{09}},
  pages        = {{209--209}},
  title        = {{Neuroendocrine Prostate Cancer: FDG-PET and Targeted Molecular Imaging}},
  url          = {{http://dx.doi.org/10.1016/j.ijrobp.2014.05.772}},
  doi          = {{10.1016/j.ijrobp.2014.05.772}},
  year         = {{2014}},
}