• Etienne Lavallée, Michelle Bergeron, François-Alexandre Buteau, Annie-Claude Blouin, Nicolas Duchesnay, Thierry Dujardin, Rabi Tiguert, Louis Lacombe, Vincent Fradet, Molière Makao-Nguile, Yves Fradet, Jean-Mathieu Beauregard, and Frédéric Pouliot.
• Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Québec City, Canada; Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine and Cancer Research Center, Université Laval, Québec City, Canada; Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec-Université Laval, Québec City, Canada.
• Eur Urol Focus. 2019 Nov 1; 5 (6): 998-1006.

BackgroundThe accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to stage prostate cancer (PCa) is limited. However, Gleason 8-10 PCa and more aggressive metastatic PCa have been shown to exhibit a higher glycolytic activity.ObjectiveTo evaluate the potential of intraprostatic FDG uptake to prognose Gleason 8-10 PCa patients prior to prostatectomy, based on tumour intrinsic biology.Design, Setting, And ParticipantsFDG-PET/CT and a bone scan were performed as a staging procedure prior to prostatectomy in 148 consecutive patients diagnosed with PCa with a Gleason sum of ≥8 at biopsy.Outcome Measurements And Statistical AnalysisThe FDG-PET/CT images were blind reviewed. Lymph node (LN) metastasis and intraprostatic FDG uptake were systematically recorded, and correlated with the patients' clinicopathological characteristics.Results And LimitationsFDG-PET/CT detected foci of intraprostatic FDG uptake in 66% of patients. An intraprostatic FDG uptake of maximum intraprostatic standardised uptake value (SUVmax) of ≥4.6 was statistically significantly associated with a higher pathological Gleason ≥8, extracapsular extension, seminal vesicle invasion, and pathological LN metastasis. In multivariate analysis, an intraprostatic SUVmax of ≥4.6 was associated with a two-fold increased risk of biochemical recurrence in the year following surgery. Patients with an intraprostatic SUVmax of ≥4.6 had estimated median biochemical recurrence-free survival (BFS) of 11.3mo compared with 49.5mo for those with a lower SUVmax. Finally, high intraprostatic FDG uptake was associated with shorter time to castration resistance following radical prostatectomy (RP).ConclusionsPreoperative intraprostatic FDG uptake is an integrator of adverse pathological prognostic factors, predicting BFS and castration resistance following RP in patients with a Gleason score ≥8 PCa at biopsy. These results support the use of preoperative FDG-PET/CT as a tool to distinguish at diagnosis very high-risk Gleason 8-10 PCa patients in whom novel neoadjuvant or adjuvant therapies should be explored.Patient SummaryThis study shows that an increased use of glucose by prostate cancer cells detected by 18F-fluorodeoxyglucose positron emission tomography molecular imaging can identify aggressive prostate cancers.Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

39 keywords...

hide…