Planning of External Beam Radiotherapy for Prostate Cancer Guided by PET/CT

In this paper, we give an overview of articles on non-choline tracers for PET/CT for patients with prostate cancer and planning of radiotherapy guided by PET/CT. Nineteen articles described (11)C-Acetate PET/CT. Of 629 patients 483 (77%, 95% CI 74% - 80%) had positive (11)C-Acetate PET/CT scans. Five articles described (18)F-FACBC PET/CT. Of 174 patients, 127 (73%, 95% CI 68% - 78%) had positive scans. Both tracers detected local lesions, lesions in regional lymph nodes, and distant organs. Ten articles described (18)F-NaF PET/CT and found that 1289 of 3918 patients (33%) had positive reactive lesions in bones. PET/CT scan can guide external beam radiotherapy (EBRT) planning for patients with loco-regional prostate cancer. In six studies with 178 patients with localized prostate cancer, PET/CT pointed out dominant intraprostatic lesions (DIL). Oncologists gave EBRT to the whole prostate and a simultaneously integrated boost to the DIL. Four studies with 254 patients described planning of EBRT for patients with PETpositive lymph nodes. After the EBRT, 15 of 29 node-positive patients remained in remission for median 28 months (range 14 to 50 months). Most articles describe (11)C- and (18)F-Choline PET/CT. However, (11)C-Acetate and (18)F-FACBC may also be useful tracers for PET/CT. Planning of radiotherapy guided by MRI or PET/CT is an investigational method for localized prostate cancer. Current clinical controlled trials evaluate whether the method improves overall survival.