Page 16 - Towards personalized therapy for metastatic prostate cancer: technical validation of [18F]fluoromethylcholine

Chapter 1
energy alpha particles with short range radiation induce double-stranded DNA breaks, resulting in a highly localized cytotoxic effect in the target areas [18].
Figure 1. Patient with CRPC, before and after therapy with Enzalutamide (MDV3100). (Illustration reproduced with permission from Scher et al., Ref. 11).
Sagittal and coronal views of two PET scans, 1 h after administration of 16β-18F-fluoro-5α-dihydrotestosterone (FDHT), in the same patient with CRPC, are presented. The top row shows the fused PET/CT images at baseline and the bottom row the fused PET/CT scan 4 weeks after treatment with Enzalutamide. Both the sagittal and coronal images, at baseline and 4 weeks after start of Enzalutamide therapy, show a reduction in FDHT accumulation in the tumor within the vertebrae, compared with the cardiac and aortic blood pool, in which FDHT metabolites circulate bound to serum proteins.
However, despite the variety of therapeutic options, proper sequencing (e.g., modality, timing) in individual patients with PC is unclear. Furthermore, the economic impact of these therapies has to be taken into account, due to the relatively high costs. To this end, it is essential, both from an ethical and an economical perspective, to opt for tailored therapies. This means developing “instruments” able to identify which phenotype
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