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Multimodality imaging: prostate cancer diagnosis and follow up by TOF-PET & MRI/MRS F. Garibaldi – INFN Roma and ISS - importance of ear;ly diagnosis -

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Presentation on theme: "Multimodality imaging: prostate cancer diagnosis and follow up by TOF-PET & MRI/MRS F. Garibaldi – INFN Roma and ISS - importance of ear;ly diagnosis -"— Presentation transcript:

1 Multimodality imaging: prostate cancer diagnosis and follow up by TOF-PET & MRI/MRS F. Garibaldi – INFN Roma and ISS - importance of ear;ly diagnosis - PET - MRI - PET/MRI - TOF-PET challenges - choice of scintillator - the readout - summary and outlook

2 Advanced molecular imaging techniques in the detection, diagnosis, therapy, and follow-up of prostate cancer F. Garibaldi, Italian National Insitute of Health and INFN Rome1, gr. Sanita

3 Advanced molecular imaging techniques in the detection, diagnosis, therapy, and follow-up of prostate cancer F. Garibaldi, Italian National Insitute of Health and INFN Rome1, gr. Sanita Workshop on Compton Camera Applications to Bio-medical Imaging Mattinata 5-7 September 2002 Frontiers in Imaging science: high performance detectors for vascular disease (brain and heart) imaging based on the latest developments in scintillators, photodetectors, and solid state materials Rome - ISS - 12,13,14 November 2006

4 DECEMBER :00 I. Opening session (Chairman: Prof. F. Di Silverio, University La Sapienza,Rome, Italy- Prof. F.Micali,University Tor Vergata) 10:50 II. Prostate Cancer Diagnosis (Chairman: Prof. F. Di Silverio University La Sapienza, Rome, Italy) 14:30 III. New techniques (Chairman: Prof. A. Stefanini, University Pisa, A.Tubaro, University La Sapienza, Rome, Italy) 16:20 IV. Staging (Chairman:Prof.F. Micali,University Tor Vergata, Rome, Italy DECEMBER :30 V. Therapy and follow up (Chairman: Prof. L. Miano, University La Sapienza, Rome, Italy) 14:30 VI. Satellite Technical Workshop on New Nuclear Medicine Detectors For Imaging Prostate Cancer

5 55/100,000 per year in Europe 9000 new cases/year in Italy Prostate cancer is the most common cancer and the second leading cause of cancer death in Italian men INCIDENCE Prostate Cancer Diagnosis: MRI

6 Most common solid tumor in men over 50 PROSTATE CANCER

7 PSA level Sensitivit y Specificit y 1,1 ng/ml83,438,9 1.6 ng/ml6758,7 2.1 ng/ml52,672,5 2.6 ng/ml40,581,1 3.1 ng/ml32,286,7 4.1 ng/ml20, ng/ml4,698,5 8.1 ng/ml1,799, ng/ml 0,999,7 Any Cancer (n.: 1225) VS No Cancer (n: 4362 pts) Thompson IM, JAMA 2005 PSA: Sensitivity and Specificity PSA remains an important prognostic markers of the biological potential of newly diagnosed prostatic cancer and the best marker to evaluate treatment outcome. It will be a challenge to the medical community to change the long- held notion that there is a normal PSA value at which to recommended biopsy. PSA proxy as Age, PSA Density, PSA velocity, Free PSA, ACT- PSA, BPSA can help the physician in the decision making process. Future markers or tools for the early detection of clinically significant prostate cancer and to avoid unnecessary biopsy are strongly needed. Cutoff?

8 Recent INDICATIONS for BIOPSY Abnormal PSA level DRE + false negative false positive BIOPSY TRUS (hypoechoic lesion) normal DRE and PSA Not necessarily BIOPSY PROSTATE CANCER

9 PSA DRE TRUS CONCLUSION I level II level BIOPSY MRI and Spectroscopy

10 BIOPSIA PROSTATICA ECOGUIDATA LA NEOPLASIA PROSTATICA Volume < 50 g 8 prelievi Volume > 50 g 12 prelievi

11 ECOGRAFIA TRANSRETTALE CON DOPPLER LA NEOPLASIA PROSTATICA

12 55/100,000 per year in Europe 9000 new cases/year in Italy Prostate cancer is the most common cancer and the second leading cause of cancer death in Italian men INCIDENCE Prostate Cancer Diagnosis: MRI

13 State of Art *Catalona WJ, Smith DS,Ornstein DK et al. JAMA 277: , 2004 **Langer JE et al. Semin Roentgenol 34: ,, 2004 DRE PSA Sensibility PSA level 4.0 ng/ml % PSA level > 4.0 ng/ml % TRUS Normal DRE and PSA < 4.0 ng/ml Do not exclude prostate cancer* DIAGNOSTIC PITFALLS 30% palpable lesions at DRE False Positive high rate 20% hypoechoic lesions are truly malignant** EARLY DIAGNOSIS PITFALLS Prostate Cancer Diagnosis: MRI

14 MRI: Morphologic Imaging % (97% for known lesions) low score for lesions < 5 mm Carcinoma of the Prostate Gland: MRI Imaging with Pelvic Phased-Array Coils vs Integrated Endorectal-Pelvic Phased-Array Coils. Radiology 1994;193: Prostate Cancer Diagnosis: MRI Sensitivity for Prostate Cancer

15 55% High false positive scores (low intensity areas at T2 mapping) Prostate Cancer: Effect of Postbiopsy Hemorrhage on Interpretation of MR Images. Radiology 1995;195: Prostate Cancer Diagnosis: MRI MRI: Morphologic Imaging Specificity for Prostate Cancer

16 Prostate Cancer

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36 Single Photon: 111 In-ProstaScint PET: 11 C-choline 11 C-acetate 18 F-fluorocholine (FCH) Prostate Rectum Collimato r Gamma Imager S. Majewski Jefferson Lab W. Moses LBL N. Clinthorne. Michigan

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40 . Magnetic Resonance spectroscopic imaging (MRSI) provides a noninvasive invasive method of detecting small molecular markers (metabolites) within the cytosol or in extracellular spaces of the prostate and is performed in conjunction with high spatial resolution (.55 x.55 mm, x 3 mm) anatomic imaging. Commercial packages to perform prostate MRI/MRSI in a clinical setting are becoming available and Multi-site clinical trials of prostate MRI/MRSI are underway.s


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