Russell H. Morgan Department of Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland 21231, USA.
Curr Top Med Chem. 2010;10(16):1600-16. doi: 10.2174/156802610793176774.
Prostate cancer (PCa) is the second leading cause of cancer deaths in American men. Early detection of PCa by blood tests for elevated levels of prostate-specific-antigen (PSA) has lead to early treatment and a reduction in death rates. However, PSA level alone does not distinguish between PCa and normal conditions that cause elevated PSA. Furthermore, because PCa can be a very slow growing cancer, even confirmation of PCa cells in a biopsy gives no indication whether the PCa will progress into active disease within the individual's lifetime. As a result many patients receive treatment that they may not need. Imaging is an attractive modality for the detection and characterization of disease because most techniques are non- or minimally invasive, nondestructive, provide dynamic real-time data, and allow for repeat measurements. In PCa, advanced imaging techniques could be useful for accurate staging of primary disease, restaging of recurrent disease, detection of metastatic lesions, and predicting the aggressiveness of the disease. This paper reviews the radionuclide based imaging agents for planar, single photon emission computed tomography (SPECT), and positron emission tomography (PET) imaging currently used in the clinic and those under development for PCa. The former includes the bone agents technetium diphosphonates and F-18 fluoride, the metabolic agents 2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG), and receptor targeted radiolabeled monoclonal antibodies including ProstaScint. The latter agents include C-11 acetate, C-11 and F-18 choline, C-11 and F-18 labeled 1-aminocyclobutane-1-carboxylic acid, radiolabeled androgen receptor binding compounds, radiolabeled peptides and small molecules for receptors over expressed either on prostate cancer itself or on the associated tumor neovasculature. Coregistration of PET or SPECT images with CT or MRI scans, improvements in imaging cameras, and image reconstruction algorithms have improved the quality of the images to the point where dual modality (radionuclide/CT or MRI) imaging with several agents can now be considered for staging of PCa. In addition, the high selectivity and rapid localization of many of the new agents under development portends promise for a greater use of radionuclide imaging for prostate cancer detection, characterization, and treatment monitoring.
前列腺癌(PCa)是美国男性癌症死亡的第二大主要原因。通过血液检测前列腺特异性抗原(PSA)水平升高来早期发现 PCa,已经导致了早期治疗和死亡率的降低。然而,PSA 水平本身并不能区分 PCa 和导致 PSA 升高的正常情况。此外,由于 PCa 可能是一种生长非常缓慢的癌症,即使在活检中确认了 PCa 细胞,也不能表明 PCa 会在个体的一生中发展为活动性疾病。因此,许多患者接受了他们可能不需要的治疗。成像技术是检测和诊断疾病的一种有吸引力的方法,因为大多数技术是非侵入性或微创性的,不会造成破坏性影响,提供动态实时数据,并允许重复测量。在 PCa 中,先进的成像技术可用于准确分期原发性疾病、复发性疾病的分期、转移性病变的检测以及预测疾病的侵袭性。本文综述了目前临床上使用的核素基平面成像剂、单光子发射计算机断层扫描(SPECT)和正电子发射断层扫描(PET)成像剂,以及用于 PCa 的正在开发的成像剂。前者包括骨显像剂锝双膦酸盐和 F-18 氟化物、代谢显像剂 2-[¹⁸F]氟-2-脱氧-D-葡萄糖(FDG)以及受体靶向放射性标记的单克隆抗体,包括 ProstaScint。后者包括 C-11 乙酸盐、C-11 和 F-18 胆碱、C-11 和 F-18 标记的 1-氨基环丁烷-1-羧酸、放射性标记的雄激素受体结合化合物、放射性标记的肽和小分子,用于在前列腺癌本身或相关肿瘤新生血管中过度表达的受体。PET 或 SPECT 图像与 CT 或 MRI 扫描的配准、成像相机的改进和图像重建算法的提高,已经将图像质量提高到可以考虑使用多种显像剂进行 PCa 分期的程度。此外,许多正在开发的新制剂的高选择性和快速定位预示着放射性核素成像在前列腺癌检测、诊断和治疗监测方面的应用将更加广泛。
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