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. 2021 Jan 28;124(7):1187–1198. doi: 10.1038/s41416-020-01224-6

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 3 — Hyperpolarised ¹³C-MRI in a patient with metastatic prostate cancer undergoing androgen deprivation therapy before and after 6 weeks of treatment initiation.⁶⁹ Representative axial T2-weighted (T2W) anatomic image and corresponding apparent diffusion coefficient (ADC) image, T2W image with an overlaid pyruvate-to-lactate metabolic exchange rate (k_PL) image and corresponding hyperpolarised ¹³C spectral array are shown. The 52-year-old prostate cancer patient with extensive high-grade prostate cancer was imaged a before therapy and b 6 weeks after initiation of androgen ablation and chemotherapy. Before treatment, the region of prostate cancer can be clearly seen (red arrows) as a reduction in signal on the T2W and ADC images, and increased hyperpolarised lactate and associated k_PL on hyperpolarised ¹³C-MRI. After initiation of androgen deprivation therapy there was a significant reduction in hyperpolarised lactate and k_PL to normal levels, with the prostate volume and ADC showing only a modest response to treatment. Reprinted from European Urology, volume 72, Aggarwal, R., Vigneron, D. B. & Kurhanewicz, J., Hyperpolarized 1-[13C]-pyruvate magnetic resonance imaging detects an early metabolic response to androgen ablation therapy in prostate cancer, pages 1028–1029, Copyright (2017), with permission from Elsevier.