IMPROVED PROSTATE CANCER STAGING WITH DUAL MODE IMAGING

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Prostate cancer is a significant health problem among men in the United States with an estimated 179,300 new cases being diagnosed and an estimated 37,000 deaths in 1999. Appropriate selection of therapy depends heavily on clinical staging and current staging techniques are inadequate. 111In-capromab pendetide (11IIn- ProstaScint) is a radiolabeled monoclonal antibody that has been introduced to assess patients with prostate cancer. The purpose of the proposed research is to develop improved localization and quantification methods for 111In-ProstaScint using a unique imaging system that combines x-ray computed tomography (CT) with single photon emission tomography (SPECT) to provide more accurate staging for prostate cancer patients. Within this clinical context, the project will focus on three specific aims: (1) Development of an iterative reconstruction algorithm that incorporates the dual-energy nature of the "'In gamma-ray emission, provides attenuation compensation, and accounts for the limited spatial resolution of the nuclear medicine collimator; (2) Assessment of the clinical advantages of CT/SPECT for 111In- ProstaScint imaging of patients with prostate cancer; (3) Comparison of quantitative assessment of 111In-ProstaScint images with CT/SPECT to visual interpretation of the SPECT images alone. Methods using CT/SPECT to improve the image quality and quantitative accuracy of 111In-ProstaScint images will be developed by (a) incorporating corrections from CT into the SPECT reconstruction and quantitation process and (b) augmenting the radionuclide images with anatomical information from the coregistered CT image. The long-term goal of this work is to develop an effective method of assessing primary disease and metastatic progression of prostate cancer using CT/SPECT imaging of tumor-specific radiopharmaceuticals. Our objective is to improve the accuracy of clinical staging of prostate cancer allowing for the selection of appropriate treatment. Better selection of patients who would benefit from localized radiotherapy, systemic hormonal therapy, further surgery, or even initial radical prostatectomy should reduce unnecessary risk to patients, improve therapeutic results, and promote cost- effectiveness of health care spending for diagnosis and treatment of prostate cancer overall.