Investigation on tumor hypoxia in resectable primary prostate cancer as demonstrated by 18F-FAZA PET/CT utilizing multimodality fusion techniques

Rita Garcia-Parra, David Wood, Rajal B. Shah, Javed Siddiqui, Hero Hussain, Hyunjin Park, Timothy Desmond, Charles Meyer, Morand Piert

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Purpose: As hypoxia is believed to play an important role in the development and progression of prostate cancer, we evaluated whether 18F-labeled fluoroazomycin arabinoside ( 18F-FAZA) would be useful to identify tumor hypoxia in resectable prostate cancer. Methods: Positron emission tomography (PET)/CT was performed on 14 patients with untreated localized primary prostate cancer 3 h post-injection of approximately 390 MBq of 18F-FAZA using forced diuresis to decrease radioactivity in the urinary bladder. Anatomical trans-pelvic coil and pre-and post-contrast 1.5 T MRI with endorectal coil were performed on the same day. Patients underwent radical prostatectomy and ex vivo 3 T MRI of the prostatectomy specimen within 14 days following in vivo imaging. Imaging results were verified by whole mount histopathology plus tissue microarray (TMA) immunohistochemical (IHC) analysis for carbonic anhydrase IX (CAIX) and hypoxia-inducible factor 1α(HIF-1α). Registration of in vivo imaging with histology was achieved using mutual information software and performing ex vivo MRI of the prostatectomy specimen and whole mount sectioning with block face photography as intermediate steps. Results: Whole mount histology identified 43 tumor nodules, 19 of them larger than 1 ml as determined on coregistered volumes featuring 18F-FAZA, MRI, and histological 3-D image information. None of these lesions was found to be positive for CAIX or visualized by 18F-FAZA PET/CT while IHC for HIF-1αshowed variable staining of tumor tissues. Accordingly, no correlation was found between 18F-FAZA uptake and Gleason scores. Conclusion: Our data based on 18F-FAZA PET/CTand CAIX IHC do not support the presence of clinically relevant hypoxia in localized primary prostate cancer including highgrade disease. Activation of HIF-1αmay be independent of tissue hypoxia in primary prostate cancer.

Original languageEnglish (US)
Pages (from-to)1816-1823
Number of pages8
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number10
StatePublished - Oct 2011
Externally publishedYes


  • CAIX
  • F-FAZA
  • Fluoroazomycin arabinoside
  • HIF-1α
  • Hypoxia
  • Immunohistochemistry
  • MIB-1/Ki-67
  • PET/CT
  • PET/MRI fusion
  • Prostate cancer

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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