FDG PET-CT in Metastatic Prostate Cancer

描述(申请人提供)：由于预期寿命的增加，前列腺癌将成为流行的男性健康问题。目前迫切需要对转移性前列腺癌患者进行准确的影像评估。目前最常用的示踪剂[F-18]-氟代脱氧葡萄糖(FDG)的正电子发射断层扫描(PET)已成为一种重要的癌症诊断成像手段。成像技术的最新进展也导致了双模式PET-CT系统的出现，这种系统可以精确融合解剖和代谢成像数据。我们初步的体外细胞培养、动物体内和初步临床研究已经提供了令人信服的证据，证明FDG PET可能在转移性前列腺癌患者的影像评估中具有重要作用。这项研究计划有两个具体目的：1)评估FDG PET-CT在评估两组临床不同的转移性前列腺癌患者治疗反应中的诊断价值，I组：新诊断的激素未确诊的转移性疾病患者将接受标准雄激素消融治疗，以及II组：新出现的激素难治性转移性癌症患者，将接受标准化疗，以及2)评价FDG PET-CT在预测患者预后方面的价值。我们假设，半定量FDG PET-CT监测转移性前列腺癌病变的葡萄糖代谢的系列变化在客观评估治疗反应和预测关键临床结果方面比传统方法具有竞争优势。为了验证这一假设，我们将进行一项前瞻性队列研究，以评估系列FDG PET-CT成像在确定肿瘤对雄激素消融治疗或化疗的代谢反应以及预测关键临床结果(如激素耐受状态的时间和生存期)方面的诊断和预后价值。严格的统计学方法将被用来确定FDG PET-CT在此临床环境中的诊断和预后性能。

DESCRIPTION (provided by applicant): Prostate cancer will become an epidemic male health problem due to increasing life expectancy. There is a critical need for accurate imaging evaluation of patients with metastatic prostate cancer. Positron emission tomography (PET) with the most common tracer currently available, [F-18]-fluorodeoxyglucose (FDG), has emerged as an important diagnostic imaging modality in cancer. Recent advances in imaging technology have also resulted in dual-modality PET-CT systems that allow precise fusion of anatomic and metabolic imaging data. Our preliminary in-vitro cell culture, animal in-vivo, and pilot clinical studies have provided compelling evidence that FDG PET may have a significant role in the imaging evaluation of patients with metastatic prostate cancer. There are two specific aims for this research proposal: 1) to assess the diagnostic utility of FDG PET-CT in the evaluation of therapy response in two clinically distinct groups of patients with metastatic prostate cancer, Group I: men with newly diagnosed hormone-naive metastatic disease who will be treated with the standard androgen ablation therapy, and Group II: men with newly developed hormone-refractory metastatic cancer who will be treated with standard chemotherapy, and 2) to evaluate FDG PET-CT in predicting patient outcome. We hypothesize that semi-quantitative FDG PET-CT monitoring of the serial changes in the glucose metabolism of metastatic prostate cancer lesions provides a competitive advantage over the conventional methods in the objective assessment of treatment response and in predicting key clinical outcomes. To test this hypothesis, we will perform a prospective cohort study to evaluate the diagnostic and prognostic utility of serial FDG PET-CT imaging in determining tumor metabolic response to either androgen ablation therapy or to chemotherapy and in predicting key clinical outcomes such as time to hormone-refractory state and survival. Rigorous statistical methods will be applied to determine the diagnostic and prognostic performance of FDG PET-CT in this clinical setting.