[11C]choline PET/CT imaging in occult local relapse of prostate cancer after radical prostatectomy (original) (raw)
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Choline PET/CT in recurrent prostate cancer
Frontiers in Oncology
PurposeBiochemical recurrence (BR) occurs in up to 40% of patients with prostate cancer (PCa) treated with primary radical prostatectomy (RP). Choline PET/CT may show, in a single-step examination, the site of tumor recurrence earlier than traditional imaging methods, particularly at low prostate-specific antigen (PSA) levels, thus influencing subsequent treatment. Methods/patientsPatients with recurrent and non-metastatic prostate cancer (nmPCa), who were assessed with choline PET/CT, were included in the analysis. Based on imaging results, the following therapeutic strategies were chosen: radiotherapy to the prostatic bed, androgen deprivation therapy (ADT), and chemotherapy or stereotactic body radiotherapy (SBRT) to either the pelvic lymph nodes or distant metastases. We assessed the impact of age, PSA levels, Gleason score (GS), and adjuvant therapy on oncological outcomes.ResultsData from 410 consecutive nmPCa patients with BR who underwent RP as primary treatment were analyze...
Role of 18F-Choline PET/CT in Biochemically Relapsed Prostate Cancer After Radical Prostatectomy
Clinical Nuclear Medicine, 2013
The aim of this study was to evaluate the efficacy of 18 F-choline PET/CT (18FCH-PET/CT) in restaging patients previously treated by radical prostatectomy for a prostate cancer, presenting with biochemical relapse during follow-up (FU). Patients and Methods: Three hundred thirty-one patients referred to us from January 2009 to April 2011 to perform 18FCH PET/CT were evaluated: 233 of them (mean age 69.7 years) met the inclusion criteria of the study: (1) biochemical relapse after radical prostatectomy (trigger PSA 90.2 ng/mL) (n = 224) and (2) high risk for relapse (elevated Gleason score Q8) in spite PSA G0.1 ng/mL during FU (n = 9). Trigger PSA was available for all patients (mean 8 ng/mL) and in 44 of them also PSA kinetic (PSA velocityVPSAvel; PSA doubling timeVPSAdt). Correlation between 18FCH PET/CT detection rate and trigger PSA, PSAvel, PSAdt, and tumoral spread distribution were evaluated by univariate and multivariate analysis. Subsequent minimum FU was 1 year (mean 26 months, range 12Y40). Results: Overall detection rate of 18FCH PET/CT was 54%, which significantly increased when the trigger PSA increases (P G 0.001). PET-positive patients presented a ''fast'' PSA kinetic (mean PSAdt = 6 months and mean PSAvel = 9.3 ng/mL/yr), while PET-negative patients presented a ''slow'' PSA kinetic (mean PSAdt = 15.4 months and mean PSAvel = 0.9 ng/mL/yr). Disease relapse was local in 17% of cases, distant in 66%, and combined in 17%. Conclusions: Overall 18FCH PET/CT detection rate was 54% (ie, similar to that reported in literature with 11 C-choline), which increases with the increase in trigger PSA: this condition was particularly true in patients with accelerated PSA kinetic. In about 20% of patients, 18FCH PET/CT demonstrated local relapses early enough to offer locoregional radiation therapy.
Journal of Nuclear Medicine, 2014
The aim of the study was to assess which factors may influence 11 C-choline PET/CT detection rate in a population of recurrent prostate cancer (PCa) patients listed for salvage radiation therapy (S-RT) in an early phase of biochemical relapse, to select which patients could obtain the most benefit by performing restaging 11 C-choline PET/CT before S-RT. Methods: The study comprised 605 patients, treated with radical prostatectomy (RP) with curative intent for PCa who showed rising PSA levels after primary therapy and listed for S-RT. Prostate-specific antigen (PSA) values were .0.2 ng/mL and ,2 ng/mL (mean, 1.05 ng/mL; median, 1.07 ng/mL; range, 0.2-2 ng/m; SD, ±0.59). All patients were classified as N0 after RP. Seventeen of 605 patients received adjuvant RT together with RP, whereas 148 of 605 patients received androgen-deprivation therapy (ADT) at the time of PET/CT. PSA, PSA kinetics, Gleason score, age, time to biochemical relapse, ADT, and initial tumor stage were statistically analyzed to assess which factor could influence PET/CT positivity and the detection of local versus distant relapse.
Radiotherapy and Oncology, 2011
Background and purpose: The present study evaluates the incidence of 11 C-choline PET/CT positive findings in patients with recurrent prostate cancer referred for salvage radiotherapy (SRT) and the influence on the definition of the planning target volume (PTV). Material and methods: Thirty-seven patients treated with radical prostatectomy and referred to SRT to the prostatic fossa because of biochemical relapse, were analysed retrospectively. All patients underwent 11 C-choline PET/CT before radiotherapy. The influence of PET/CT on the extent of the PTV was analysed. The median total follow up after SRT was 51.2 months. Results: 11/37 (30%) patients had a positive finding in the 11 C-choline PET/CT, 5 (13%) outside of the prostatic fossa (iliac lymph nodes), implicating an extension of the PTV. Patients with positive 11 C-choline PET/CT had a significant higher PSA value than patients with no pathologic uptake (p = 0.03). Overall, at the end of follow up 56% of the patients had a PSA 6 0.2 ng/ml and 44% had a biochemical relapse of prostate cancer.
Choline PET or PET/CT and Biochemical Relapse of Prostate Cancer
Clinical Nuclear Medicine, 2013
Aim: The increase of prostate-specific antigen (PSA) after radical retropubic prostatectomy (RP) or external beam radiotherapy (EBRT) is the most sensitive tool for detecting prostate cancer (PCa) recurrence, although this measure cannot distinguish between local, regional, or distant recurrence. The aim of this meta-analysis was to evaluate the diagnostic performance of 18 F-choline and 11 C-choline PET or PET/CT in detection of locoregional or distant metastases in PCa. Materials and Methods: Medline, Web of Knowledge, and Google Scholar search was carried out in order to select English-language articles dealing with diagnostic performance of both 18 F-choline and 11 C-choline PET for the detection of PCa recurrence after RP or EBRT. Articles were included only if absolute numbers of true-positive, true-negative, false-positive, and falsenegative test results were available or derivable from the text and regarded local, lymph node, and distant metastases. Reviews, clinical reports, and editorial articles were excluded. All complete studies were re-analyzed thus performing a quantitative analysis. Results: From the years 2000 to 2012, we found 53 complete articles that critically evaluated the role of choline PET in restaging patients with PCa recurrence. The meta-analysis was carried out and dealt with 19 selected studies (12 studies for all sites of disease, 3 for lymph node metastases, and 4 for local recurrence), with a total of 1555 patients. The meta-analysis provided a pooled sensitivity of 85.6% (95% CI: 82.9%Y88.1%) and pooled specificity of 92.6% (95% CI: 90.1%Y94.6%) for all sites of disease (prostatic fossa, lymph nodes, and bone), a pooled sensitivity of 75.4% (95% CI: 66.9%Y82.6%) and pooled specificity of 82% (95% CI: 68.6%Y91.4%) for prostatic fossa recurrence, and a pooled sensitivity of 100% (95% CI: 90.5%Y100%) and pooled specificity of 81.8% (95% CI: 48.2%Y97.7%) for lymph node metastases. The heterogeneity ranged between 0.00% and 88.6%. The diagnostic odds ratios were 62.123 (95% CI: 24.783Y155.72), 5.869 (95% CI: 1.818Y18.946), and 138.57 (95% CI: 11.27Y1703.8), respectively, for all sites of disease, local recurrence, and lymph node disease. Conclusions: Choline PET and PET/CT represent high sensitivity and specificity techniques for the detection of locoregional and distant metastases in PCa patients with recurrence of disease. Moreover, a high diagnostic odds ratio was found for the identification of lymph node disease in patients with biochemical recurrence of PCa. Lymph Node Mets Prostatic Fossa Relapse Pooled Value (95% CI) Pooled Value (95% CI) Sensitivity 100% (90.5Y100) 75.4% (66.9Y82.6) Specificity 81.8% (48.2Y97.7) 82.0% (68.6Y91.4) Positive likelihood ratio 3.72 (0.98Y14.17) 2.35 (1.03Y5.39) Negative likelihood ratio 0.03 (0.05Y0.23) 0.44 (0.26Y0.74) Diagnostic odds ratio 138.5 (11.27Y1703.8) 5.86 (1.81Y18.94) Mets indicate metastases. identification of relapse in PCa patients are a PSA value 91 ng/mL, PSAvel 91 ng/mL/year, and a PSAdt G3 months. Ongoing hormonal therapy does not represent a limitation in diagnostic accuracy. Conversely, choline PET/CT does not seem indicated for the detection of local recurrence.
2013
Approximately 40% of patients managed with radical treatment for localized prostate cancer (PCa) will develop biochemical relapse. Recently, a synthetic L-leucine analogue, anti-1-amino-3-18F-fluorocyclobutane-1carboxylic acid (anti-3-18F-FACBC) has been proposed as a promising radiopharmaceutical agent to detect PCa recurrences, alternative to 11C-choline. In our study, anti-3-18F-FACBC positron emission tomography (PET)/computed tomography (CT) showed a higher detection rate compared with 11C-choline, with approximately 20% of additional patients and 60% of additional lesions detected. Introduction: The aim of our study was to compare the detection rate of anti-3-18F-FACBC PET/CT in comparison with 11C-choline PET/CT in the evaluation of disease recurrence of PCa after radical prostatectomy. Patients and Methods: Twenty-eight consecutive patients with biochemical relapse after radical prostatectomy were submitted to anti-3-18F-FACBC PET/CT and 11C-choline PET/CT to evaluate the site of disease recurrence. Androgen deprivation therapy was avoided in all cases. The primary end point was the overall detection rate of the 2 radiotracers. A patient-based analysis and a lesion-based analysis was performed. The target to background ratio (TBR) of each lesion was reported. Results: At the time of PET scan, mean age was 67 years and mean prostate specific antigen (PSA) relapse was 2.9 ng/mL (range: 0.2-14.6). In patient-based analyses, 11C-choline PET/CT was positive in 5 patients and negative in 23 (detection rate ¼ 17.8%) and anti-3-18F-FACBC PET/CT was positive in 10 patients and negative in 18 (detection rate ¼ 35.7%). All lesions that were positive using 11C-choline were positive using anti-3-18F-FACBC PET/CT but with the latter radiotracer, 11 (61.1%) additional tumors were identified including 5 (17.8%) additional patients. The TBR of anti-3-18F-FACBC was greater than 11C-choline in 15 of 18 lesions, confirming a better image quality and contrast. Conclusion: This preliminary study demonstrated that the detection rate of anti-3-18F-FACBC PET/CT is greater in comparison with 11C-choline, with approximately 20% of additional patients and approximately 60% additional lesions detected. Further studies, however, are required to assess the exact added value of this new tracer.
European Journal of Nuclear Medicine and Molecular Imaging, 2010
Purpose Detection of recurrence in prostate cancer patients with biochemical failure after radical prostatectomy by [ 11 C]choline PET/CT depends on the prostate-specific antigen (PSA) level. The role of other clinical and pathological variables has not been explored. Methods A total of 2,124 prostate cancer patients referred to our Institution for [ 11 C]choline PET/CT from December 2004 to January 2007 for restaging of disease were retrospectively considered for this study. Inclusion criteria were: previous treatment by radical prostatectomy, and biochemical failure, defined as at least two consecutive PSA measurements of >0.2 ng/ml. These criteria were met for 358 patients. Binary logistic analysis was used to investigate the predictive factors of [ 11 C]choline PET/CT. PET/CT findings were validated using criteria based on histological analysis, and follow-up clinical and imaging data. Receiver operating characteristic (ROC) analysis was used to assess the performance of [ 11 C]choline PET/CT in relation to PSA levels. Results The mean PSA level was 3.77±6.94 ng/ml (range 0.23-45 ng/ml; median 1.27 ng/ml). PET/CT was positive for recurrence in 161 of 358 patients (45%). On an anatomical region basis, [ 11 C]choline pathological uptake was observed in lymph nodes (107/161 patients, 66%), prostatectomy bed (55/161 patients, 34%), and in the skeleton (46/161 patients, 29%). PET/CT findings were validated using histological criteria (46/358, 13%), and follow-up clinical and imaging criteria (312/358, 87%). Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were, respectively, 85%, 93%, 91%, 87%, and 89%. In multivariate analysis, high PSA levels, advanced pathological stage, previous biochemical failure and older age were significantly (P< 0.05) associated with an increased risk of positive PET/CT findings. The percentage of positive scans was 19% in those with a PSA level between 0.2 and 1 ng/ml, 46% in those with a PSA level between 1 and 3 ng/ml, and 82% in those with a PSA level higher than 3 ng/ml. ROC analysis showed that PET/CT-positive and PET/CT-negative patients could be best distinguished using a PSA cutoff value of 1.4 ng/ml. Conclusions In addition to PSA levels, pathological stage, previous biochemical failure and age should be considered by physicians when referring prostate cancer patients with biochemical failure after radical prostatectomy to [ 11 C]choline PET/CT.
Clinical Indications of 11 C-Choline PET/CT in Prostate Cancer Patients with Biochemical Relapse
Theranostics, 2012
Several studies investigated the potential role of imaging modalities in prostate cancer patients in case of biochemical recurrence. However, the role of molecular imaging has not been well established yet. Considering the results of the literature and of our own experience, we tried to summarize the potential applications of 11 C-choline PET/CT in prostate cancer patients in case of biochemical relapse for the detection of lymph node and distant recurrence.
Clinical Nuclear Medicine
Aim: The increase of prostate-specific antigen (PSA) after radical retropubic prostatectomy (RP) or external beam radiotherapy (EBRT) is the most sensitive tool for detecting prostate cancer (PCa) recurrence, although this measure cannot distinguish between local, regional, or distant recurrence. The aim of this meta-analysis was to evaluate the diagnostic performance of 18 F-choline and 11 C-choline PET or PET/CT in detection of locoregional or distant metastases in PCa. Materials and Methods: Medline, Web of Knowledge, and Google Scholar search was carried out in order to select English-language articles dealing with diagnostic performance of both 18 F-choline and 11 C-choline PET for the detection of PCa recurrence after RP or EBRT. Articles were included only if absolute numbers of true-positive, true-negative, false-positive, and falsenegative test results were available or derivable from the text and regarded local, lymph node, and distant metastases. Reviews, clinical reports, and editorial articles were excluded. All complete studies were re-analyzed thus performing a quantitative analysis. Results: From the years 2000 to 2012, we found 53 complete articles that critically evaluated the role of choline PET in restaging patients with PCa recurrence. The meta-analysis was carried out and dealt with 19 selected studies (12 studies for all sites of disease, 3 for lymph node metastases, and 4 for local recurrence), with a total of 1555 patients. The meta-analysis provided a pooled sensitivity of 85.6% (95% CI: 82.9%Y88.1%) and pooled specificity of 92.6% (95% CI: 90.1%Y94.6%) for all sites of disease (prostatic fossa, lymph nodes, and bone), a pooled sensitivity of 75.4% (95% CI: 66.9%Y82.6%) and pooled specificity of 82% (95% CI: 68.6%Y91.4%) for prostatic fossa recurrence, and a pooled sensitivity of 100% (95% CI: 90.5%Y100%) and pooled specificity of 81.8% (95% CI: 48.2%Y97.7%) for lymph node metastases. The heterogeneity ranged between 0.00% and 88.6%. The diagnostic odds ratios were 62.123 (95% CI: 24.783Y155.72), 5.869 (95% CI: 1.818Y18.946), and 138.57 (95% CI: 11.27Y1703.8), respectively, for all sites of disease, local recurrence, and lymph node disease. Conclusions: Choline PET and PET/CT represent high sensitivity and specificity techniques for the detection of locoregional and distant metastases in PCa patients with recurrence of disease. Moreover, a high diagnostic odds ratio was found for the identification of lymph node disease in patients with biochemical recurrence of PCa. Lymph Node Mets Prostatic Fossa Relapse Pooled Value (95% CI) Pooled Value (95% CI) Sensitivity 100% (90.5Y100) 75.4% (66.9Y82.6) Specificity 81.8% (48.2Y97.7) 82.0% (68.6Y91.4) Positive likelihood ratio 3.72 (0.98Y14.17) 2.35 (1.03Y5.39) Negative likelihood ratio 0.03 (0.05Y0.23) 0.44 (0.26Y0.74) Diagnostic odds ratio 138.5 (11.27Y1703.8) 5.86 (1.81Y18.94) Mets indicate metastases. identification of relapse in PCa patients are a PSA value 91 ng/mL, PSAvel 91 ng/mL/year, and a PSAdt G3 months. Ongoing hormonal therapy does not represent a limitation in diagnostic accuracy. Conversely, choline PET/CT does not seem indicated for the detection of local recurrence.