2013-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645809摘要：攝護腺癌是台灣男性癌症死因的第七位， 在2011 年就有 1096 位台灣男性因攝護腺癌而死亡。 在攝護腺癌初次被診斷後, 目前雖然已經有被大家廣泛接受的根治性治療方法, 但是復發還是不少見. 當攝護腺特異抗原PSA被偵測到或偵測到持續上升時, 是一個最早復發的癥兆. 這時如何後續治療就需要根據復發病灶的部位, 大小及影響範圍等來做治療計劃. 傳統影像, 包括骨骼掃描, 電腦斷層, 核醫免疫掃描, 甚至 MRI 和 18F-FDG PET 都有其限制性。膽鹼 (choline) 是磷脂醯膽鹼(phosphatidylcholine) 的主要成份，這些磷脂質是細胞膜的重要成份。因為攝護腺癌細胞會將膽鹼合成磷脂醯膽鹼及磷脂質來促進加速細胞的複製，所以攝護腺癌細胞內膽鹼激脢(choline kinase) 較正常或肥大的攝護腺細胞增加相當多。2010-2011年在歐洲已經有數國 (包括法國、波蘭、斯洛維尼亞、德國及奧地利等) 通過18F-fluorocholine (FCH) PET 用於偵測定位原發、復發或轉移攝護腺癌的確病灶。2012年九月在美國也已通過梅約臨床中心使用11C-choline 運在攝護腺癌。因此, 在台灣推動 choline PET 運用在攝護腺癌病灶, 更是刻不容緩的事情。因為18F-FCH 正子掃描能幫助臨床早期診斷並精確定位復發攝護腺癌病灶，對攝護腺癌患者後續治療計劃及預後將有重大影響力。本院迴旋加速器暨製藥中心已有能力製備18F-FCH。2010年八月至-2011年七月本院泌尿部、腫瘤醫學部、影像醫學部及核子醫學部所組成的攝護腺癌團隊已從事了一年的先導研究, 納入33位患者, 初步顯示有很好的效益。因此本團隊希望繼續本為期三年的研究，納入更多患者，以18F-FCH 正子造影來研究 (1) 在早期偵測攝護腺癌治療後復發病灶的效益， (2) 偵測率和攝護腺特異抗原PSA動態變化的關係， (3) 和攝護腺磁振造影的比較及互補性。 期待本研究成果不僅具有學術價值, 也可以成為未來申請使用 18F-FCH 正子造影在攝護腺癌在台灣申請臨床運用的一項有力的輔佐證據。<br> Abstract: Prostate cancer is the 7th leading cause of cancer death for male in Taiwan. Although the initial curative therapeutic modalities for prostate cancer have been well established, recurrences are not uncommon after initial treatment. Detectable or increasing serum prostate-specific antigen (PSA) is the earliest evidence of residual or recurrent disease. Subsequent treatment decision making relies on the extent of recurrent disease. Nevertheless, conventional imaging techniques including computed tomography (CT), bone scan, immunoscintigraphy, MRI and 18F-FDG PET have been shown to be less effective in detecting recurrent prostate cancer. 11C or 18F choline PET has been demonstrated to be highly promising in imaging prostate cancer. It has been shown that choline kinase is significantly up-regulated in prostate cancer cells. Several PET probes targeted to choline kinase have been developed for clinical utilization using 11C-choline or 18F-fluorocholine (FCH). In 2010-2011, IASOcholine , which is [18F] fluorocholine PET tracer, has been approved to “marketing” in several counties including France, Poland, Slovenia, Germany and Austria. The U.S. Food and Drug Administration (FDA) have also approved production and use of 11C-choline for PET imaging in recurrent prostate cancer in The Mayo Clinic PET Radiochemistry Facility (Rochester, MN) on September, 2012. It is likely that other centers will seek permission of choline probes in the near future. From August, 2010 to July, 2011, we performed a pilot study that using 18F-FCH PET in diagnosing prostate cancer with promising preliminary results. Therefore, the objectives of this study is to perform a continuing study with a larger patient scale for patients with biochemical relapse after initial curative therapy, to evaluate 1. the detection rate of 18F-FCH PET for recurrent/metastatic disease; 2. the correlation between detection rate and PSA kinetics (trigger PSA, PSA velocity and PSA doubling time); 3. comparison and incremental value of combined interpretation of PET and MR imaging. We hope the results may not only have academic achievements but also can become a strong evidence-based supplement data for applying in the clinical utilization of choline PET in Taiwan in the near further.攝護腺癌18F-氟-膽鹼正子造影攝護腺特異抗原磁振造影