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NM By Myself > Male Cancer NM > Flashcards

Male Cancer NM Flashcards

1
Q

Prostate cancer N

A

True pelvis below bifurcation of common iliac arteries
N1 - - stage IV

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2
Q

Prostate cancer M

A

Bone 90% - - lumbar spine >cervical - - M1b
Lung
Liver
Pleura

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3
Q

ISUP and Gleason

A
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4
Q

PSA

A

Nonspecific
Increase with age, size, prostatitis
Elevated - - rectal exam - - US, CT, MRI
TRUS - - >26 mm - - 92% detection rate
Doubling time >6 m– recurrence

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5
Q

Prostate cancer CT, MRI

A

CT - - staging in high volume disease
Not accurate for intraprostatic, local staging
MRI - - PI-RADS–local staging

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6
Q

Radionuclide therapy Lu177

A

Beta, 490 keV
Max tissue penetration 2 mm - - better irradiation
Gamma, 208 and 113 keV - - image
T1/2 6.73 days
3-8 GBq up to 6 injections at 6 weeks interval
Slow IV, 5 ml
Hydration before and after 1.5 l
Remain in hospital 2-4 h
Freeze salivary gland for 30 min before

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7
Q

Radionuclide therapy Ra223 dichloride

A

Xofigo
Alpha, penetration <100 microm - - lethal DNA damage - - lower hematological toxicity
T1/2 11.43 days
Indication: castration - resistant cancer, symptomatic bone MTS, no visceral MTS
Accumulate: bones, areas of high bone turnover
Slow IV, 3.85 MBq (194 microCi) for 70 kg
6 administrations at 4 weeks interval

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8
Q

Xofigo before treatment

A

Hb>10
Abs neutrophil count >1.5*10^9 l
PLT >100
Subsequent: abs neutrophil count >1, PLT > 50
No fast, well hydration
Stop Calcium, Phosp, Vit D for 4 days before and after

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9
Q

Xofigo objective marker of response

A

PSA and AlcPhos

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10
Q

Xofigo side effects

A

Fecal excretion > renal
Combi with chemo - - jaw osteonecrosis

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11
Q

Bone scan indication for prostate cancer

A

PSA>10 mg/ml
High Gleason
Locally advanced
Elevated AlcPhos
Bone symptoms

Monitor response to treatment
After treatment - - symptomatic patient or after biochemical recurrence

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12
Q

Bone scan sensitivity

A

More sensitive than CT
Sensitivity 75-95%
PSA >50 ng/mL - - up to 50% likely bone MTS

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13
Q

Bone scan false positive

A

Osteochondrosis
Inflammation
Trauma

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14
Q

Bone scan interpretation

A

Flare phenomenon - - between 2w and 3m after chemo - - good response
Continued increase >6 m - - disease progression - - superscan
Androgen deprivation therapy - - gynecomastia

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15
Q

F-fluoride PET/CT
F-NAF

A

Same mechanism and indication as bone scan
Response to treatment - - better performance than bone scan
Sensitivity 91%
Specificity 83%
40-100 microCi/kg, max 370 MBq for obese
Image 90-120 min after IV
Same interpretation

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16
Q

FDG PET for prostate cancer

A

Low grade - - low levels of GLUT1 - - low uptake
Aggressive - - high uptake - - poor prognosis
Biochemical recurrence - - high uptake

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17
Q

C11-choline PET

A

Cyclotron
T1/2 20 min
370-740 MBq
3-5 min after IV
Excretion through liver, little activity in urinary tract
ADT reduce uptake of C-choline in Androgen sensitive cancer

18
Q

F-choline PET

A

4.1 MBq/kg
60-90 min

19
Q

Choline PET

A

Phosphorylated by choline kinase - - trapped within cancer cells
Fast 4-6h, but not strictly necessary
Hydration
Physiologic uptake - - salivary glands, liver, pancreas, renal parenchyma, urinary bladder
Main limitation - - low specificity

20
Q

F-choline PET indication

A

Initial staging of high risk - - Gleason >7, PSA>20, T2c-3a
Restaging - - uptake higher in patients with higher PSA, higher Gleason, shorter PSA doubling time
Localisation if negative biopsy but elevated PSA - - specificity 25%
Treatment monitor - - esp if PSA>4 ng/ml
Radiotherapy planning

21
Q

Increased PSMA expression correlates with

A

High tumor grade
Advanced pathological state
Aneuploidy
Biochemical recurrence
Androgen independent tumor

22
Q

GA68-PSMA indication

A

Primary staging in high risk before surgery or radio (PSA>20 , Gleason >7, T2c-3a
Staging before and during PSMA directed radiotherapy in metastatic castration resistant cancer - - low uptake - - contra for radiopharm therapy
Targeted biopsy after negative biopsy
Localisation of recurrent cancer with low PSA 0. 2-10
Monitoring of treatment
Not to replace MRI in local delineation

23
Q

GA68-PSMA

A

T1/2 67.63 min, generator
1.8-2.2 MBq/kg
No fast, hydration
60 min after IV
Physiologic uptake - - lacrimal, salivary gland, liver, spleen, colon, kidney (proximal renal tubules), epididymis, ovary, small intestine (luminal side of ileum-jejunum), astrocytes in CNS

24
Q

PSMA other cancer

A

Colon. Bladder
Pancreas
Esophagus
Thyroid
Lung
RCC
Brain
Benign tissue

25
Q

PSMA pitfall

A

Celiac ganglia - - misinterpretation of retriperitoneal LN
Paget disease
Stellate or other ganglia
Ribs

26
Q

F-PSMA

A

Better spatial resolution
Shorter positron range
More accurate Quantification
No need for chelator to bind radiometal

27
Q
A

F-choline

28
Q
A

FDG
Penile cancer

29
Q
A

FDG in testicular cancer

30
Q

Testicular cancer germ cell 95%

A

Seminoma 50% - - radiosensitive, poor prognosis
Non Seminoma 50% - - early MTS to retriperitoneal

31
Q

Testicular cancer non germ cell

A

Sex cord and stromal tumor - - Leydig, Sertoli, Granulosa cell, Fibroma-thecoma
Tumors with both sex cord and stromal cells and germ cells - - gonadoblastoma

32
Q

Testicular cancer serum

A

AFP, hCG, LDH

33
Q

Testicular cancer biopsy

A

No
Lead to nonperitoneal lymphatic dissemination of tumor cells

34
Q

Testicular cancer MRI

A

Complicated cases
Accurate dd Seminoma (multinodular homogenous) vs non Seminoma (heterogenous mass with cystic changes and calcification)

35
Q

Testicular cancer CT

A

Insensitive
Only LN, MTS

36
Q

Residual mass and normal marker
Testicular cancer

A

FDG
Negative - - surveillance
Positive - - surgery, biopsy

37
Q

Testicular cancer FDG indication

A

Not for initial evaluation
SUV >3 - - cutoff for suspicion of malignancy
Equivocal findings on CT
Elevated markers and negative CT
Post chemo residual GCT mass >3 cm - - dd residual vs fibrosis 6 weeks after chemo - - repeat in 6 weeks
Not for post chemo restaging of non GCT
Post chemo residual non GCT mass - - false negative - - necrosis, vital carcinoma, mature teratoma (chemo resistant, FDG avid)

38
Q

Testicular cancer
FDG diagnosis and staging

A

Sensitivity 75%
Specificity 80%
Non seminoma - - lower sensitivity
False negative - - partial volume effect on small lesions

39
Q

Stunned tumor

A

Mass with residual malignancy remain negative on FDG for 10-14 days after chemo

40
Q

Penile cancer FDG

A

No role in primary neoplasm
Staging if palpable LN
Response to chemo
Inguinal LN
Bladder catheter to avoid urine contamination
20 mg IV fusid 20 min after FDG - - accelerate renal clearance
20 mg butylscopolamine - - decrease intestinal activity

41
Q

F-fluciclovine
F-FACBC PET

A

Proliferation and angiogenesis
High uptake in liver, red bone marrow, lung, pancreas
Minimal excretion through kidneys
4-5 min after IV
Sensitivity directly correlates with PSA concentration, inversely correlate to PSA doubling time
Similar uptake in benign hyperplasia

NM By Myself (25 decks)

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