Disease States

Prostate Cancer

Prostate cancer is a major public health problem, being the most common cancer diagnosis for men in the United States and the second leading cause of cancer related death (1). A man born today has a lifetime risk of 1 in 7 of developing prostate cancer and a 1 in 36 chance of dying from the disease (2).

Since the advent of Prostate Specific Antigen (PSA) blood testing most prostate cancer is detected while still localised to the prostate gland , enabling treatment by surgical prostatectomy and/or radiation therapy (3). Patients are monitored with PSA testing after treatment and although often curative, approximately 30% of treated men experience a recurrence of their cancer, detected as a rising PSA (4). This is termed biochemical failure or biochemical recurrence (BCR).

Biochemical Recurrence

Prostate cancer may occur locally in the prostate gland or prostate bed, or may have spread to the lymph nodes in the pelvis or more distantly, or to the bone(5). Treatment choice is dependent on an understanding of the location of recurrent disease, as well as patient preferences, of course. Techniques such as radiotherapy or cryotherapy may be used for local recurrences, especially at lower levels of PSA, whereas use of anti-hormonal therapy and/or chemo or immunotherapy may be recommended in the presence of metastases (3).

The rates of detection of disease spread beyond the prostate or prostate bed by conventional imaging is typically very low, 11% in one analysis(6), and a significant un-met need exists for more sensitive imaging to detect locations of recurrence.

Glioma

256,213 new cases of brain or CNS tumors were diagnosed in 2012, resulting in an estimated 189,382 deaths (7) and brain cancers are the most common solid tumor type in children (8). A sub-type of brain tumors (the gliomas) make up about 27% of all types above and constitute about 80% of all malignant brain tumors (8).

In both primary and recurrent glioma there is a significant need to improve the delineation of tumor extent and to differentiate between progression and pseudo-progression (9). BED is investigating the role of fluciclovine(18F) to address this un-met need.