FDG PET-CT in Metastatic Prostate Cancer

描述（由申请人提供）：随着寿命的延长，前列腺癌将成为男性健康的流行病。对转移性前列腺癌患者进行准确的影像学评估是非常必要的。正电子发射断层扫描（PET）是目前最常见的示踪剂[F-18]-氟脱氧葡萄糖（FDG），已成为癌症诊断的重要成像方式。成像技术的最新进展也导致了双模态PET-CT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学评估中发挥重要作用。本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效用，第一组：新诊断为激素初始转移性疾病的男性，将接受标准雄激素消融治疗，第二组：新发展的激素难治性转移性癌症患者将接受标准化疗；2)评估FDG PET-CT对患者预后的预测。我们假设FDG PET-CT半定量监测转移性前列腺癌病变糖代谢的一系列变化，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FDG PET-CT连续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（如激素难治性状态和生存时间）方面的诊断和预后效用。严格的统计方法将用于确定FDG PET-CT在临床环境中的诊断和预后表现。

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.