Evaluation of tumor hypoxia prior to radiotherapy in intermediate-risk prostate cancer using 18F-fluoromisonidazole PET/CT: a pilot study

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// Stéphane Supiot 1, 2, * , Caroline Rousseau 1, 2, * , Mélanie Dore 1, 2 , Catherine Cheze-Le-Rest 3 , Christine Kandel-Aznar 4 , Vincent Potiron 1, 2 , Stéphane Guerif 3 , François Paris 1, 2 , Ludovic Ferrer 1, 2 , Loïc Campion 1, 2 , Philippe Meingan 1 , Gregory Delpon 1, 2 , Mathieu Hatt 5 and Dimitris Visvikis 5 1 Institut de Cancérologie de l'Ouest, Bld Jacques Monod, 44805 Nantes-Saint Herblain, France 2 Centre de Recherche en Cancérologie Immunologie Nantes/Angers (CRCNA, UMR 1232 INSERM), Institut de Recherche en Santé de l'Université de Nantes, 44007 Nantes CEDEX 1, France 3 Centre Hospitalier Universitaire, 86021 Poitiers, France 4 Centre Hospitalier Universitaire, 44000 Nantes, France 5 Laboratoire de Traitement de l'Information Médicale (LaTIM), INSERM, UMR 1101, IBSAM, UBO, UBL, IBRBS, Faculté de Médecine, 29238 Brest, France * These authors contributed equally to this work Correspondence to: Stéphane Supiot, email: Stephane.supiot@ico.unicancer.fr Keywords: hypoxia; prostate cancer; misonidazole; FAZA; HIF Received: August 29, 2017 Accepted: December 11, 2017 Published: January 13, 2018 ABSTRACT Purpose: Hypoxia is a major factor in prostate cancer aggressiveness and radioresistance. Predicting which patients might be bad candidates for radiotherapy may help better personalize treatment decisions in intermediate-risk prostate cancer patients. We assessed spatial distribution of 18 F-Misonidazole (FMISO) PET/CT uptake in the prostate prior to radiotherapy treatment. Materials and Methods: Intermediate-risk prostate cancer patients about to receive high-dose (>74 Gy) radiotherapy to the prostate without hormonal treatment were prospectively recruited between 9/2012 and 10/2014. Prior to radiotherapy, all patients underwent a FMISO PET/CT as well as a MRI and 18 F-choline-PET. 18 F-choline and FMISO-positive volumes were semi-automatically determined using the fuzzy locally adaptive Bayesian (FLAB) method. In FMISO-positive patients, a dynamic analysis of early tumor uptake was performed. Group differences were assessed using the Wilcoxon signed rank test. Parameters were correlated using Spearman rank correlation. Results: Of 27 patients (median age 76) recruited to the study, 7 and 9 patients were considered positive at 2.5h and 3.5h FMISO PET/CT respectively. Median SUV max and SUV max tumor to muscle (T/M) ratio were respectively 3.4 and 3.6 at 2.5h, and 3.2 and 4.4 at 3.5h. The median FMISO-positive volume was 1.1 ml. Conclusions: This is the first study regarding hypoxia imaging using FMISO in prostate cancer showing that a small FMISO-positive volume was detected in one third of intermediate-risk prostate cancer patients.