Dynamic PET in prostate cancer: basic concepts and potential applications

Introduction PSMA PET/CT has emerged as imaging modality of choice in the management of Prostate cancer which is useful from theraonostic viewpoint as well. Dynamic PET/CT provides unique advantage of registering pharmacokinetic information. We hereby provide overview of dynamic PET/CT imaging and its potential utility in Prostate Cancer. Methods We reviewed existing literature on principles of dynamic PET imaging, tracer kinetic modelling, and studies performed using dynamic imaging in Prostate cancer using appropriate search criteria on PubMed and SCOPUS. Dynamic PET/CT imaging enables the visualization of various aspects of tracer kinetics. Tracer kinetic modelling employs compartments which are macroscopic subsystems in an observed system. Although different protocols of dynamic imaging can be employed, none is proven to be superior to others, and dynamic acquisition for 60 min just after tracer injection is the frequently used protocol in most of the studies for Prostate Cancer. Two tissue compartment modelling-based quantitative evaluation is performed. Images are visualized in qualitative, semiquantitative, quantitative (two-tissue compartment modelling) and fractal analysis. Four rate constants have been described for tracer exchange between plasma and tissue subsequently. Results Addition of early dynamic imaging to the routine imaging protocol may increase detection rate for local recurrence in Prostate Cancer. Molecular mapping of static and dynamic images would be helpful in identification of areas of tumor heterogeneity. Dynamic imaging has also the potential to help in planning targeted therapy. It also helps to differentiate pathological activity from the greater physiological bladder activity in delayed static images. Dynamic PET/CT imaging showed increasing tracer uptake during the dynamic PET acquisition as well as high binding and internalization of the PSMA radioligand in the Prostate cancer lesions. Conclusion Addition of early dynamic PET/CT imaging in to the routine static protocol after tracer injection has the potential to further improve the diagnostic accuracy and detection rate of local recurrence in PC. Dynamic imaging in Prostate cancer is a largely unexplored arena which may play an important role in evolving optimal in management of Prostate cancer and further larger uniform studies are warranted.