Exploring new molecular imaging concepts of prostate cancer

Prostate cancer is diagnosed in the Netherlands every year in approximately 10,000 new patients and about 2500 patients die each year due to the disease. Imaging techniques play a key role in the staging of the disease and help to make a right choice between the available treatment options. Nuclear medical techniques are used in particular for detecting metastases, of which lymph node metastases and skeletal metastases occur most frequently in prostate cancer patients. Radiopharmaceuticals with proven potential for detecting prostate cancer cells that are investigated in this thesis include: 99mTc-MDP, 99mTc-HDP, NaF, 11C-choline, 18F-fluorocholine and 18F-DCFPyL. By means of a literature study and own data, it became clear that NaF PET/CT and Choline PET/CT are more suitable for detecting skeletal metastases than scintigraphy with 99mTc-MDP or HDP, which has been used for decades. Besides skeletal metastases, soft tissue metastases, for example lymph node metastases, can be detected with Choline or 18F-DCFPyL PET/CT. Various aspects were investigated that could affect the efficacy of these techniques. It became clear that it is of value to scan immediately after administration of Choline and about 45 minutes later. Fasting for several hours before Choline PET/CT has no additional value. Choline PET/CT has little value in the detection of primary lesions or a recurrence in the prostate itself. For 18F-DCFPyL more prostate cancer lesions are seen in 39% of patients at a scan 120 minutes post injection as compared to a scan 60 minutes post injection.