11C]Choline PET/CT in therapy response assessment of a neoadjuvant therapy in locally advanced and high risk prostate cancer before radical prostatectomy

Sarah M Schwarzenböck,Jens Kurth,Anna Knieling,Margitta Retz,Hubert Kübler,Katja Steiger,Markus Schwaiger,Matthias Eiber,Bernd J Krause,Mark Thalgott,Jürgen E Gschwend,Irene Esposito,Michael Souvatzoglou

doi:10.18632/oncotarget.11653

Abstract

PurposeRecent studies have shown promising results of neoadjuvant therapy in prostate cancer (PC). The aim of this study was to evaluate the potential of [11C]Choline PET/CT in therapy response monitoring after combined neoadjuvant docetaxel chemotherapy and complete androgen blockade in locally advanced and high risk PC patients.ResultsIn [11C]Choline PET/CT there was a significant decrease of SUVmax and SUVmean (p = 0.004, each), prostate volume (p = 0.005) and PSA value (p = 0.003) after combined neoadjuvant therapy. MRI showed a significant prostate and tumor volume reduction (p = 0.003 and 0.005, respectively). Number of apoptotic cells was significantly higher in prostatectomy specimens of the therapy group compared to pretherapeutic biopsies and the control group (p = 0.02 and 0.003, respectively).Methods11 patients received two [11C]Choline PET/CT and MRI scans before and after combined neoadjuvant therapy followed by radical prostatectomy and pelvic lymph node dissection. [11C]Choline uptake, prostate and tumor volume, PSA value (before/after neoadjuvant therapy) and apoptosis (of pretherapeutic biopsy/posttherapeutic prostatectomy specimens of the therapy group and prostatectomy specimens of a matched control group without neoadjuvant therapy) were assessed and tested for differences and correlation using SPSS.ConclusionsThe results showing a decrease in choline uptake after combined neoadjuvant therapy (paralleled by regressive and apoptotic changes in histopathology) confirm the potential of [11C]Choline PET/CT to monitor effects of neoadjuvant therapy in locally advanced and high risk PC patients. Further studies are recommended to evaluate its use during the course of neoadjuvant therapy for early response assessment.

Highlights

Prostate cancer is the most common malignancy in men worldwide and the second most common cause of cancer-related deaths in men [1]
11 patients received two [11C]Choline positron emission tomography/ computed tomography (PET/CT) and magnetic resonance imaging (MRI) scans before and after combined neoadjuvant therapy followed by radical prostatectomy and pelvic lymph node dissection. [11C]Choline uptake, prostate and tumor volume, PSA value and apoptosis were assessed and tested for differences and correlation using SPSS
The results showing a decrease in choline uptake after combined neoadjuvant therapy confirm the potential of [11C]Choline PET/CT to monitor effects of neoadjuvant therapy in locally advanced and high risk prostate cancer (PC) patients

Summary

Introduction

Prostate cancer is the most common malignancy in men worldwide and the second most common cause of cancer-related deaths in men [1]. Thalgott et al 2014 [11] prospectively evaluated a presurgical short-term combination therapy (complete androgen blockade and docetaxel therapy) in 30 locally advanced and high risk prostate cancer patients before RPE. Besides morphological changes, such as a decrease in size (as detected by MRI), metabolic changes might occur during neoadjuvant therapy These metabolic changes can be detected using functional imaging modalities, such as positron emission tomography/ computed tomography (PET/CT), which has been used successfully in the preclinical as well as clinical setting for therapy response assessment in different tumor entities [12,13,14]. Little data are available on the use of [11C]Choline PET/CT in monitoring response to neoadjuvant therapy in primary prostate cancer [17, 18]

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