1. F. Garibaldi – INFN Roma and ISS
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. Frontiers in Imaging science:
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
9:00 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
 8:30 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. INCIDENCE 55/100,000 per year in Europe 9000 new cases/year in Italy
Prostate Cancer Diagnosis: MRI
INCIDENCE
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

6. Most common solid tumor in men over 50
PROSTATE CANCER
Most common solid tumor in men over 50

7. PSA: Sensitivity and Specificity
Any Cancer (n.: 1225) VS
No Cancer (n: 4362 pts)
PSA level
Sensitivity
Specificity
1,1 ng/ml
83,4
38,9
1.6 ng/ml 67
58,7
2.1 ng/ml
52,6
72,5
2.6 ng/ml
40,5
81,1
3.1 ng/ml
32,2
86,7
4.1 ng/ml
20,5
93.8
6.1 ng/ml
4,6
98,5
8.1 ng/ml
1,7
99,4
10.1 ng/ml
0,9
99,7
Cutoff?
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.
Thompson IM, JAMA 2005

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

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

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

11. LA NEOPLASIA PROSTATICA
ECOGRAFIA TRANSRETTALE
CON DOPPLER

12. INCIDENCE 55/100,000 per year in Europe 9000 new cases/year in Italy
Prostate Cancer Diagnosis: MRI
INCIDENCE
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

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

14. 75 - 90% Sensitivity for Prostate Cancer (97% for known lesions)
Prostate Cancer Diagnosis: MRI
MRI: Morphologic Imaging
Sensitivity for Prostate Cancer %
(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:

15. 55% Specificity for Prostate Cancer High false positive scores
Prostate Cancer Diagnosis: MRI
MRI: Morphologic Imaging
Specificity for Prostate Cancer
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:

16. Prostate Cancer

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

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