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The aim of this work was to evaluate 82 Rb PET/CT as a diagnostic tool for quantitative tumor blood flow (TBF) imaging in prostate cancer (PCa). Study 1 was performed to evaluate 82 Rb as a marker of TBF, using 15 O-H 2 O PET as a reference method. Study 2 investigated the ability of 82 Rb uptake measurements to differentiate between PCa and normal prostate. Methods: Study 1: 9 PCa patients scheduled for radical prostatectomy were included. Prostate multiparametric MRI and both cardiac and pelvic 15 O-H 2 O PET and 82 Rb PET were performed. PET findings were compared with postprostatectomy Gleason grade group (GGG). Study 2: 15 primary high-risk PCa patients and 12 controls without known prostate disease were included in a clinical drug trial (EudraCT 2016-003185-26). 68 Ga-prostate-specific membrane antigen PET/CT scans of PCa patients were available. Pelvic 82 Rb PET was performed. Results: Study 1: both 82 Rb K  1 and 82 Rb SUVs correlated strongly with 15 O-H 2 O TBF (ρ = 0.95, P &lt; 0.001, and ρ = 0.77, P = 0.015, respectively). 82 Rb SUV and K  1 were linearly correlated ( r = 0.92, P = 0.001). 82 Rb SUV correlated with postprostatectomy GGG (ρ = 0.70, P = 0.03). Study 2: 82 Rb SUV in PCa (3.19 ± 0.48) was significantly higher than prostate 82 Rb SUV in healthy controls (1.68 ± 0.37) ( P &lt; 0.001), with no overlap between groups. Conclusion: Study 1 shows that 82 Rb PET/CT can be used for TBF quantification and that TBF can be estimated by simple SUV and suggests that 82 Rb SUV is associated with postprostatectomy GGG and, hence, cancer aggressiveness. Study 2 shows that 82 Rb uptake is significantly higher in PCa than in normal prostate tissue with no overlap between cohorts, confirming the primary hypothesis of the clinical trial. Consequently, 82 Rb PET/CT may have potential as a noninvasive tool for evaluation of tumor aggressiveness and monitoring in nonmetastatic PCa.

Quantitative Tumor Perfusion Imaging with 82Rb PET/CT in Prostate Cancer: Analytic and Clinical Validation

Quantitative Tumor Perfusion Imaging with ⁸²Rb PET/CT in Prostate Cancer: Analytic and Clinical Validation