Positron emission tomography with 11C-acetate and 18F-FDG in prostate cancer patients

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Abstract
Visualisation of primary prostate cancer, its relapse and its metastases is a clinically relevant problem despite the availability of state-of-the-art methods such as CT, MRI, transrectal ultrasound and fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET). The aim of this study was to evaluate the efficacy of carbon-11 acetate and 18F-FDG PET in the detection of prostate cancer and its metastases. Twenty-five patients were investigated during the follow-up of primary prostate cancer, suspected relapse or metastatic disease using 11C-acetate PET; 15 of these patients were additionally investigated using 18F-FDG PET. Fourteen patients were receiving anti-androgen treatment at the time of the investigation. Lesions were detected in 20/24 (83%) patients using 11C-acetate PET and in 10/15 (75%) patients using 18F-FDG PET. Based on the results of both PET scans, one patient was diagnosed with recurrent lung cancer. Median 18F-FDG uptake exceeded that of 11C-acetate in distant metastases (SUV =3.2 vs 2.3). However, in local recurrence and in regional lymph node metastases, 11C-acetate uptake (median SUVs =2.9 and 3.8, respectively) was higher than that of 18F-FDG (median SUVs =1.0 and 1.1, respectively). A positive correlation was observed between serum PSA level and both 11C-acetate uptake and 18F-FDG uptake. 11C-acetate seems more useful than 18F-FDG in the detection of local recurrences and regional lymph node metastases. 18F-FDG, however, appears to be more accurate in visualising distant metastases. There may be a role for combined 11C-acetate/18F-FDG PET in the follow-up of patients with prostate cancer and persisting or increasing PSA.

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