Prostate Cancer – Staging/restaging case study - Cardinal Health
Prostate Cancer – Staging/restaging case study - Cardinal Health
Prostate Cancer – Staging/restaging case study - Cardinal Health
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<strong>Prostate</strong> <strong>Cancer</strong> <strong>–</strong> <strong>Staging</strong>/<strong>restaging</strong><br />
Positron Emission Tomography (PET) is a non-invasive diagnostic imaging procedure<br />
that can provide unique information for accurate TNM staging. Many cancers exhibit<br />
increased glucose metabolic rates which can be identified with PET via the radiopharmaceutical<br />
18F-FDG. Since changes in glucose metabolism often occur before<br />
changes in anatomy (e.g. tumor growth), PET can often identify the presence of disease<br />
earlier than other anatomic imaging techniques. Early disease identification is particularly<br />
critical during the assessment of nodal involvement or the determination of the presence<br />
of metabolic disease.<br />
Prior studies and experience have convinced us that PET has a limited role in the<br />
evaluation of men with prostate cancer. However, most physicians involved with<br />
PET can point to selected <strong>case</strong>s of positive (and valuable) studies.<br />
The National Oncologic PET Registry (NOPR) was created to evaluate the efficacy<br />
and potential applicability of PET in tumors not previously covered by CMS. It began<br />
registering patients on May 8, 2006. Through February 1, 2007, of the top 10 NOPR <strong>Cancer</strong><br />
Sites, prostate was number one. Of the top 10 NOPR <strong>Cancer</strong> Site and Indications, prostate<br />
initial staging, prostate <strong>restaging</strong>, and prostate recurrence were ranked numbers two,<br />
three and four, respectively. This widespread interest in PET and prostate cancer is at least<br />
in part due to the high incidence of this disease (from birth to death, one in six men will<br />
develop prostate cancer), and the suboptimal performance of other imaging modalities.<br />
Anecdotal experience suggests that PET is most helpful in men with high Gleason scores<br />
and/or rapid PSA doubling times.<br />
<strong>Prostate</strong> <strong>Cancer</strong> <strong>–</strong> <strong>Staging</strong><br />
Sensitivity 57%<br />
Specificity Close to 100%<br />
References:<br />
Gambhir SS, Czernin J, Schwimmer J, et al: A tabulated summary of the FDG PET literature.<br />
J Nucl Med 2001, 42;: 53s-55s.<br />
Case <strong>study</strong> courtesy of Dr. Michael Kipper — Pacific Imaging and Treatment Center,<br />
San Diego, California<br />
© 2010 <strong>Cardinal</strong> <strong>Health</strong>. All rights reserved. CARDINAL HEALTH, the <strong>Cardinal</strong> <strong>Health</strong> LOGO<br />
and Essential to care are trademarks or registered trademarks of <strong>Cardinal</strong> <strong>Health</strong>.<br />
All other marks are the property of their respective owners. Lit. No. 7PET5802 (11/2010)<br />
“In selected <strong>case</strong>s I have found<br />
FDG-PET to be of great value in<br />
identifying metastatic prostate<br />
cancer and allowing me to<br />
follow my patient with imaging<br />
as well as <strong>Prostate</strong>-Specific<br />
Antigen (PSA) measurement”.<br />
— Dr. David Bodkin,<br />
Oncologist, San Diego, California<br />
cardinalhealth.com/nps
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