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PET/CT Imaging in Prostate Cancer: Indications and Perspectives for Radiation Therapy

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Radiotherapy in Prostate Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

The goal of prostate cancer therapy is to administer risk-adjusted and patient-specific treatment with maximal cancer control and minimal side effects. Modern radiation techniques such as IMRT and IGRT for example enable application of high dose irradiation to the primary/dominant intraprostatic cancer lesions, to a local recurrent nodule after radical prostatectomy, or to the loco-regional lymph node metastases. Such approaches promise to offer significantly improved long term results but require most accurate imaging tools with the ability to reliably detect not only the primary tumor and nodal involvement but more importantly to precisely indicate their location and extent. In addition presence of distant disease should be reliably detected or excluded. In this review we present a detailed overview over numerous PET/CT-studies, with emphasis on choline-PET/CT, that investigated performance of PET/CT in different clinical scenarios, spanning from the initial presentation to PSA recurrent disease. We discuss benefits and limitations of this imaging device in the primary and salvage setting from the radio-oncologists point of view. In the situation of PSA recurrence, there is increasing evidence that in addition to local salvage RT of the prostate fossa after radical prostatectomy, salvage lymph node therapy seems feasible and advantageous for a significant proportion of patients. The accuracy of choline-PET/CT depends on absolute PSA level, PSA kinetics and the investigation depth level (e.g. lesion based vs. region based vs. patient based). Incorporation of metabolic information from Choline PET/CT or other forthcoming PET-tracers with similar or higher accuracy in the process of RT treatment volume definition appears beneficial for both primary and loco-regional recurrence, when lymph node therapy is indicated.

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Authors and Affiliations

  1. Department of Radiation Oncology, Medical University of Freiburg, Robert Koch Str. 3, 79106, Freiburg, Germany

    H. C. Rischke & A. L. Grosu

  2. Department of Nuclear Medicine, Medical University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany

    H. C. Rischke

Authors
  1. H. C. Rischke
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  2. A. L. Grosu
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Correspondence to H. C. Rischke .

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Editors and Affiliations

  1. Department of Radiation Oncology, Krankenhaus der Barmherzigen, Schwestern Linz, Johannes Kepler University, Linz, Austria

    Hans Geinitz

  2. University of California, San Francisco Department of Radiation Oncology, San Francisco, California, USA

    Mack Roach III

  3. The Institute of Cancer Research Sutton, Sutton Surrey, United Kingdom

    Nicholas van As

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Rischke, H.C., Grosu, A.L. (2014). PET/CT Imaging in Prostate Cancer: Indications and Perspectives for Radiation Therapy. In: Geinitz, H., Roach III, M., van As, N. (eds) Radiotherapy in Prostate Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2014_1007

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  • DOI: https://doi.org/10.1007/174_2014_1007

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  • Print ISBN: 978-3-642-37098-4

  • Online ISBN: 978-3-642-37099-1

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