The study found that whole body PET/CT imaging with choline is significantly better than conventional imaging technologies in detecting prostate cancer in patients with biochemical relapse after radical prostatectomy. Researchers also found a strong association between PET/CT detection of recurrent cancer, PSA levels, and PSA kinetics. The authors suggest that based on the results, only patients with a high probability of having a positive scan based on PSA levels and kinetics should undergo choline PET/CT scans. By using these criteria, the number of inappropriate choline PET/CT scans can be reduced and early detection of prostate cancer relapse can be improved.

A paper examining the state of imaging technologies in diagnosing, staging, and monitoring treatment of prostate cancer is also featured in this month's journal. The paper, based on a recent workshop held at the National Cancer Institute, reviews the technologies in light of growing concerns about overdiagnosing and overtreating prostate cancer. In some cases, detectable prostate cancer is very slow-growing and remains localized in the prostate. The rate of overdiagnosis of prostate cancer-defined as diagnosis in men who would not have clinical symptoms during their lifetime-has been estimated to be as high as 50 percent. In these cases, decisions to treat the cancer could have significant side effects such as impotence and incontinence, which can affect patients' quality of life.


"Conventional imaging techniques such as CT, MRI, and ultrasound leave substantial room for improvement in determining the extent and severity of prostate cancer," said Martin Pomper, M.D., Ph.D., professor in the department of radiology and radiological science, Johns Hopkins Medical Institutions, Baltimore. "New biomarkers may soon rival PSA for monitoring the presence and extent of disease. Our brief review examines the role of new and emerging molecular imaging agents for initially diagnosing, staging, detecting recurrence after treatment and measuring response to therapy."

Despite a variety of emerging techniques and probes using multiple imaging modalities, the paper notes, a simple, accurate method for image-guided therapy within the prostate is still needed. For metastatic disease, more careful study should be conducted of combinations of markers for prostate cancer, such as androgen receptor and prostate-specific membrane antigen (PSMA), which are excellent targets for imaging and therapy. In addition, new selective serum and urinary biomarkers such as the urinary marker sarcosine should be merged with molecular imaging tools. Pomper adds, "The article by Castellucci, et. al., in this issue illustrates nicely how connecting a serum marker, in this case PSA, with imaging can facilitate choosing the correct patients for an imaging study, as well as cut back on false negative results for that study." A practical multimodality imaging approach, coupled with an array of relevant biomarkers sampled from the blood and urine, will provide the best chance for effective management of prostate cancer, the paper concludes.

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