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Fluorodeoxyglucose Positron Emission Tomography as an Outcome Measure for Castrate Metastatic Prostate Cancer Treated with Antimicrotubule Chemotherapy

Authors' Affiliations: ¹ Genitourinary Oncology Service, Departments of Medicine, ² Nuclear Medicine, ³ Department of Radiology, and ⁴ Biostatistics Service, Memorial Sloan-Kettering Cancer Center; and Weill Medical College of Cornell University, New York, New York

Requests for reprints: Michael J. Morris, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 444, New York, NY 10021. Phone: 646-422-4469; Fax: 212-988-0683; E-mail: morrism{at}mskcc.org.

Purpose: Standard imaging studies are limited as outcome measures for patients with metastatic prostate cancer. We tested the hypothesis that serial fluorodeoxyglucose positron emission tomography (FDG-PET) scans can serve as an outcome measure for patients with castrate metastatic prostate cancer treated with antimicrotubule chemotherapy.

Experimental Design: FDG-PET scans were done at baseline, 4, and 12 weeks of treatment. The average maximum standardized uptake value (SUV_maxavg) was measured in up to five lesions and was tested as the quantitative outcome measure. Prostate-specific antigen (PSA) at 4 weeks and PSA, bone scan, and soft tissue imaging at 12 weeks were considered standard outcome measures. The change in SUV_maxavg that distinguished clinically assessed progression from nonprogression was sought.

Results: Twenty-two PET scans were reviewed and compared with PSA at 4 weeks; 18 PETs were compared at 12 weeks with standard outcome measures. Applying the PSA Working Group Consensus Criteria guideline that a 25% PSA increase constitutes progression to the SUV_maxavg, PET correctly identified the clinical status of 20 of 22 patients (91%) at 4 weeks and 17 of 18 patients at 12 weeks (94%). The accuracy of PET could be further optimized if a >33% increase in PSA and SUV_maxavg were used to define progression.

Conclusion: FDG-PET is promising as an outcome measure in prostate cancer. As a single modality, it can show treatment effects that are usually described by a combination of PSA, bone scintigraphy, and soft tissue imaging. Preliminarily, a >33% increase in SUV_maxavg or the appearance of a new lesion optimally dichotomizes patients as progressors or nonprogressors.

Key Words: imaging • response criteria • outcome measures

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