Post on 27-Mar-2015
Multimodality imaging: prostate cancer diagnosis and follow up by TOF-PET &
MRI/MRSF. Garibaldi – INFN Roma and ISS - importance of ear;ly diagnosis
- PET
- MRI
- PET/MRI
- TOF-PET challenges
- choice of scintillator
- the readout
- summary and outlook
Advanced molecular imaging techniques in the detection, diagnosis, therapy, and follow-up of prostate cancer
F. Garibaldi, Italian National Insitute of Health and INFN Rome1, gr. Sanita’
Advanced molecular imaging techniques in the detection, diagnosis, therapy, and follow-up of prostate cancer
F. Garibaldi, Italian National Insitute of Health and INFN Rome1, gr. Sanita’
Workshop on Compton Camera Applications to Bio-medical
Imaging
Mattinata 5-7 September 2002
Frontiers in Imaging science: high performance detectors for vascular disease (brain and heart) imaging based on the latest developments in scintillators, photodetectors, and solid state materials
Rome - ISS - 12,13,14 November 2006
DECEMBER 6 2006
9:00 I. Opening session (Chairman: Prof. F. Di Silverio, University La Sapienza,Rome, Italy-Prof. F.Micali,University Tor Vergata)
10:50 II. Prostate Cancer Diagnosis (Chairman: Prof. F. Di Silverio University La Sapienza, Rome, Italy)
14:30 III. New techniques (Chairman: Prof. A. Stefanini, University Pisa, A.Tubaro, University La Sapienza, Rome, Italy)
16:20 IV. Staging (Chairman:Prof.F. Micali,University Tor Vergata, Rome, Italy
DECEMBER 7 2006
8:30 V. Therapy and follow up (Chairman: Prof. L. Miano, University La Sapienza, Rome, Italy)
14:30 VI. Satellite Technical Workshop on New Nuclear Medicine Detectors For Imaging Prostate Cancer
55/100,000 55/100,000 per year in Europe per year in Europe
90009000 new cases/year in Italynew cases/year in Italy
Prostate cancer is the Prostate cancer is the most common cancermost common cancer and andthe the second leading causesecond leading cause of cancer death in of cancer death in
Italian menItalian men
INCIDENCEProstate Cancer Diagnosis: Prostate Cancer Diagnosis: MRIMRI
Most common solid tumor in men over 50
PROSTATE CANCER
PSA levelSensitivit
ySpecificit
y
1,1 ng/ml 83,4 38,9
1.6 ng/ml 67 58,7
2.1 ng/ml 52,6 72,5
2.6 ng/ml 40,5 81,1
3.1 ng/ml 32,2 86,7
4.1 ng/ml 20,5 93.8
6.1 ng/ml 4,6 98,5
8.1 ng/ml 1,7 99,4
10.1 ng/ml
0,9 99,7
Any Cancer (n.: 1225) VSAny Cancer (n.: 1225) VSNo Cancer (n: 4362 pts)No Cancer (n: 4362 pts)
Thompson IM, JAMA 2005
PSA: Sensitivity and Specificity
0
50
100
150
200
<4 4 e 10 10 e 20 >20
Distribuzione casi per range di PSA
No K
K
PSA remains an important prognostic markers of the biological potential of newly diagnosed prostatic cancer and the best marker to evaluate treatment outcome.
It will be a challenge to the medical community to change the long- held notion that there is a “normal” PSA value at which to recommended biopsy.
PSA proxy as Age, PSA Density, PSA velocity, Free PSA, ACT-PSA, BPSA can help the physician in the decision making process.
Future markers or tools for the early detection of clinically significant prostate cancer and to avoid unnecessary biopsy are strongly needed.
Cutoff?
Recent INDICATIONS for BIOPSY
• Abnormal PSA level
• DRE + false negative
false positive
BIOPSY
• TRUS (hypoechoic lesion)
• normal DRE and PSA
Not necessarily
BIOPSY
PROSTATE CANCER
PSA
DRE TRUS
CONCLUSION
I level
II level
BIOPSY
MRI and Spectroscopy
BIOPSIA PROSTATICA ECOGUIDATABIOPSIA PROSTATICA ECOGUIDATA
1234 56
LA NEOPLASIA PROSTATICA
Volume < 50 g8 prelievi
Volume > 50 g12 prelievi
Tot.(%)
TP(%)
TR(%)
p≤
Ritenzione acuta 1.3 1.5 1.1 ns
Ematomaperiprostatico
0.3 0.8 0 ns
Ematoma perineo-scrotale
0.3 0.8 0 ns
Sepsi 0.3 0 0.6 ns
Tot. (%)
TP (%)
TR (%)
p≤
Febbre 1 0.8 1.1 ns Difficoltà minzionali 7.1 7.2 7 ns Dolore persistente (>48h) 1.3 2.3 0.6 ns Disuria persistente (>48h) 2.7 1.6 3.5 ns Ematuria persistente (>24h) 25.2 26.8 24.1 ns Microematuria (>10/campo) 16.3 15.8 16.7 ns Leucocituria (>10/campo) 1.7 1.6 1.8 ns Infezioni urinarie 1.7 2.4 1.2 ns
ECOGRAFIA TRANSRETTALEECOGRAFIA TRANSRETTALECON DOPPLERCON DOPPLER
LA NEOPLASIA PROSTATICA
55/100,000 55/100,000 per year in Europe per year in Europe
90009000 new cases/year in Italynew cases/year in Italy
Prostate cancer is the Prostate cancer is the most common cancermost common cancer and andthe the second leading causesecond leading cause of cancer death in of cancer death in
Italian menItalian men
INCIDENCEProstate Cancer Diagnosis: Prostate Cancer Diagnosis: MRIMRI
State of Art
*Catalona WJ, Smith DS ,Ornstein DK et al. JAMA 277: 1452-1455, 2004**Langer JE et al. Semin Roentgenol 34: 284-294,,2004
DRE
PSASensibility
PSA level ≤ 4.0 ng/ml 67.5 - 80% PSA level > 4.0 ng/ml 60 - 70%
TRUS
Normal DRE and PSA
< 4.0 ng/ml
Do not exclude prostate cancer*
DIAGNOSTIC PITFALLS• 30% palpable lesions at DRE
False Positive high rate• 20% hypoechoic lesions
are truly malignant**
EARLY DIAGNOSIS PITFALLS EARLY DIAGNOSIS PITFALLS
Prostate Cancer Diagnosis: MRI
MRI: Morphologic Imaging
75 - 90% (97% for known lesions)
low score for lesions < 5 mm Carcinoma of the Prostate Gland: MRI Imaging with Pelvic Phased-Array Coils vs Integrated Endorectal-Pelvic Phased-Array Coils. Radiology 1994;193:703-709
Prostate Cancer Diagnosis: MRI
Sensitivity for Prostate Cancer
55% High false positive scores
(low intensity areas at T2 mapping)
Prostate Cancer: Effect of Postbiopsy Hemorrhage on Interpretation of MR Images. Radiology 1995;195:385-390
Prostate Cancer Diagnosis: MRI
MRI: Morphologic Imaging
Specificity for Prostate Cancer
Prostate Cancer
Single Photon:111In-ProstaScint
PET:11C-choline11C-acetate18F-fluorocholine (FCH)
Prostate
Rectum
Collimator
GammaImager
Source
Image Plane
1st Detector
2nd DetectorScatteredγ - Rays
S. Majewski Jefferson Lab
W. Moses LBL
N. Clinthorne. Michigan
. Magnetic Resonance spectroscopic imaging (MRSI) provides a noninvasive invasivemethod of detecting small molecular markers (metabolites) within the cytosol or in extracellular spaces of the prostate and is performed in conjunction with high spatial resolution (.55 x .55 mm, x 3 mm) anatomic imaging.
• Commercial packages to perform prostate MRI/MRSI in a clinical settingare becoming available and Multi-site clinical trials of prostate MRI/MRSIare underway.s