Technologist’s Guide

Prostate Cancer Imaging and Therapy

October 2018

Prostate cancer is the second most common cancer in men worldwide. Due to increasing life expectancy and the introduction of more sensitive diagnostic screening techniques, prostate cancer is being diagnosed more frequently, with rapidly increasing incidence and prevalence. It has a wide spectrum of biological behaviour, ranging from indolent low-risk disease to highly aggressive castration-resistant prostate cancer.

Nuclear medicine imaging plays a key role in this heterogeneous disease as it can answer key clinical questions at various phases of the disease, the imaging being tailored to each phase. Nuclear medicine has demonstrated efficacy for cancer detection, with an increasing number of potential targets for imaging and treatment.

The first chapter of this book describes the prostate’s anatomy, physiology and pathology. The radiopharmaceuticals that allow study or treatment of prostate cancer are discussed in the subsequent chapter. Conventional nuclear medicine represents a cost-effective resource in the management of prostatic disease, and the third chapter documents the specific imaging procedures for diagnostic planar imaging and hybrid SPECT/CT. The following two chapters provide an overview on protocols and the diagnostic value of PET/CT imaging using fluorine-18 and other non-fluorine-18 radioisotopes labelled with different molecules. PET/CT is a useful tool for guided radiotherapy planning; consequently the sixth chapter describes the acquisition and reconstruction protocol for the purpose of radiotherapy. One of the most recent developments in nuclear medicine is theranostics: the seventh chapter reviews the state of the art, describing the use of theranostic pairs and quantitative analysis of tissue and tumour uptake in optimisation of patient treatment. The eighth chapter broadens the vision of the field of therapy, adding treatment based on alpha-emitting radionuclides. Nuclear medicine technologists play an important part in the multi-professional management of the prostate cancer patient. In addition to being directly involved in therapy through the performance of various roles, they are responsible for other tasks such as patient preparation and imaging processing. The ninth chapter describes the clinical pathway of the patient in order to improve understanding of the technologist’s tasks.

The recent advances in prostate cancer specific tracers were significantly supported by the advent of translational medicine. With this in mind, the final chapter explains how molecular and non-invasive preclinical imaging become rapidly emerging fields in preclinical cancer drug research and development.

We hope that this overview of the state of the art of nuclear medicine imaging and therapy in prostate cancer will provide a valuable resource for all technologists and clinical staff involved in this field.

The EANM Technologist Committee would like to thank all the authors who have kindly offered their time and expertise, which have been fundamental to the creation of this book.

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