FDG PET-CT in Metastatic Prostate Cancer

描述（由申请人提供）：由于预期寿命的增加，前列腺癌将成为流行性男性健康问题。目前迫切需要对转移性前列腺癌患者进行准确的影像学评价。正电子发射断层扫描（PET）与目前最常见的示踪剂，[F-18]-氟脱氧葡萄糖（FDG），已成为一个重要的诊断癌症的成像方式。成像技术的最新进展也导致了双模态PET-CT系统，其允许解剖和代谢成像数据的精确融合。我们的初步体外细胞培养、动物体内和初步临床研究提供了令人信服的证据，表明FDG PET可能在转移性前列腺癌患者的成像评估中发挥重要作用。本研究提案有两个具体目的：1）评估FDG PET-CT在评价两组临床不同的转移性前列腺癌患者的治疗反应中的诊断效用，第I组：新诊断的未经治疗的转移性疾病男性，将接受标准雄激素消融治疗，第II组：新发展的难治性转移性癌症患者将接受标准化疗，2）评估FDG PET-CT在预测患者结局方面的作用。我们假设，半定量FDG PET-CT监测转移性前列腺癌病灶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局方面，与传统方法相比具有竞争优势。为了验证这一假设，我们将进行一项前瞻性队列研究，以评估连续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局（如至肿瘤难治性状态的时间和生存率）方面的诊断和预后效用。将应用严格的统计方法来确定FDG PET-CT在该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.