18F-fluorodeoxyglucose PET

[pjoshea13]

New study below.

Dr. Myers once said good luck getting insurance to pay for a radio-labeled glucose PET scan. PCa cells tend to favor fatty acids as fuel, although they may switch to glycolysis at a later stage.

"One of the most commonly used PET tracers is 18F-fluorodeoxyglucose (FDG), which is preferentially taken up by malignant cells due to increased glucose metabolism known as the “Warburg effect”. In PCa, FDG does not accurately detect lymph node metastasis preoperatively, and it cannot be used as a reliable staging imaging technique to alter PCa management."

However, cells that have switched to glucose are apparently more aggressive. So perhaps 18F-fluorodeoxyglucose PET has a place in PCa, if such knowledge would influence treatment?

"This study shows that a homogeneous group of patients with biologically high-risk PCa (Gleason 8–10) at prostate biopsy can be subdivided into high risk and very high risk of recurrence based on their IPFU intensity, as measured by PET/CT. We also demonstrate that patients exhibiting a high IPFU had an increased risk of biochemical and castration resistance, thus revealing an aggressive behaviour of PCa foci with increased glucose uptake. Indeed, PCa with increased FDG uptake was associated with adverse pathological characteristics including a higher Gleason grade following RP. On the contrary, patients not exhibiting a high IPFU had a longer median BFS survival rate (49.5 vs 11.3 mo). Moreover, FDG-PET/CT was shown to integrate several adverse pathological prognostic factors (lymph node positivity, Gleason sum, volume of cancer, and stage) as an SUVmax value, a number that can easily be determined to guide local treatment and neoadjuvant or adjuvant therapies."

-Patrick

eu-focus.europeanurology.co...

[DenDoc]

Patrick,

Thanks for sharing this article. I am a single example of this. My FDG PET CT was negative until I became castrate resistant last August. It immediately detected lymph nodes in my mediastinum.

It was too risky to biopsy so I had to wait through some treatment failures till I had pleural lesions for a biopsy. That showed my PC had become a small cell cancer and is very aggressive.

I am presently on chemo and the FDG PET CT is what we are using to follow it.

[Coupe31]

I was in a clinical trial for this PSMA f18 pet scan at Johns Hopkins in Feb 2018. i had positive margins, Gleason 3+4 and a rising PSA of 1.2 in Dec. 2017 to 1.6 in Feb 2018. The test was negative. The pelvic MRI, CT and bone scans were all negative. The lesson from these negative imaging tests is while there wasnt any evidince of cancer spreading; there isnt any guarantee that is hasn’t. These tests have their limits when PSA is very low.