Fluoride PET/CT Skull Base to Mid-Thigh Fluoride PET/CT is not routinely used in the evaluation of prostate cancer recurrence. There is limited evidence to support its use in this setting. FDG-PET/CT Some foci of metastatic prostate cancer demonstrate increased accumulation of fluorine-18-2-fluoro-2-deoxy-D- glucose (FDG) radiotracer, although this uptake is generally low compared to the other cancers. In 1 study, FDG- PET identified local or metastatic disease in only 28 of 91 patients (31%) with BCR after RP for prostate cancer [79]. FDG-PET is relatively insensitive in detecting osseous metastases compared to standard bone scintigraphy [80]. Ghanem et al [81] have demonstrated that FDG-PET alone or using PET/CT image fusion is less sensitive than MRI in the detection of bone metastases. In the routine setting, FDG-PET has little usefulness in the setting of BCR. However, as advanced metastatic prostate cancer migrates to a high Gleason grade, dedifferentiates, or transforms to other aggressive variants, such as small cell type, the tumor cells are more likely to convert to a higher glucose metabolism, and FDG can become useful in detection and monitoring of this subset of patients. Post-Treatment Follow-up of Prostate Cancer choline PET in staging and restaging of prostate cancer [84]. In intrapatient comparisons of PSMA and fluciclovine, a higher detection rate by PSMA for extraprostatic disease especially at lower PSA levels was reported, with superiority of fluciclovine for the prostate bed, because of significantly lower urinary excretion of fluciclovine compared with PSMA [85,86]. Ga-68 has a physical half-life of 68 minutes, and its production currently requires a generator, which can allow batch production of approximately 2 to 4 patient doses per generator elution [87]. In addition, PSMA PET radiotracers may be useful to select patients for PSMA radioligand therapy, which is recently FDA approved [88].
Post Treatment Follow up of Prostate Cancer. Fluoride PET/CT Skull Base to Mid-Thigh Fluoride PET/CT is not routinely used in the evaluation of prostate cancer recurrence. There is limited evidence to support its use in this setting. FDG-PET/CT Some foci of metastatic prostate cancer demonstrate increased accumulation of fluorine-18-2-fluoro-2-deoxy-D- glucose (FDG) radiotracer, although this uptake is generally low compared to the other cancers. In 1 study, FDG- PET identified local or metastatic disease in only 28 of 91 patients (31%) with BCR after RP for prostate cancer [79]. FDG-PET is relatively insensitive in detecting osseous metastases compared to standard bone scintigraphy [80]. Ghanem et al [81] have demonstrated that FDG-PET alone or using PET/CT image fusion is less sensitive than MRI in the detection of bone metastases. In the routine setting, FDG-PET has little usefulness in the setting of BCR. However, as advanced metastatic prostate cancer migrates to a high Gleason grade, dedifferentiates, or transforms to other aggressive variants, such as small cell type, the tumor cells are more likely to convert to a higher glucose metabolism, and FDG can become useful in detection and monitoring of this subset of patients. Post-Treatment Follow-up of Prostate Cancer choline PET in staging and restaging of prostate cancer [84]. In intrapatient comparisons of PSMA and fluciclovine, a higher detection rate by PSMA for extraprostatic disease especially at lower PSA levels was reported, with superiority of fluciclovine for the prostate bed, because of significantly lower urinary excretion of fluciclovine compared with PSMA [85,86]. Ga-68 has a physical half-life of 68 minutes, and its production currently requires a generator, which can allow batch production of approximately 2 to 4 patient doses per generator elution [87]. In addition, PSMA PET radiotracers may be useful to select patients for PSMA radioligand therapy, which is recently FDA approved [88].