180 [11C]CHOLINE PET/CT SCAN PREDICTS SURVIVAL IN PROSTATE CANCER PATIENTS WITH BIOCHEMICAL FAILURE AFTER RADICAL PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: PET/CT with [11C]choline is frequently used for prostate cancer (PCa) restaging in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). However, prognostic implications of this technique are unknown. In this study, we assessed the role of [11C]choline PET/CT in predicting survival in PCa patients. METHODS: This prospective study included 165 PCa patients with BCR after RP that underwent [11C]choline PET/CT for restaging of the disease between December 2004 and January 2007 at a siongle center. Survival analyses were performed with Kaplan-Meyer method and Cox-regression analysis predicting overall survival (OS) and PCaspecific survival. RESULTS: [11C]choline PET/CT was positive in 72 of 165 patients (44%). Median follow-up was 48.2 months. The 25th percentile of OS was 35.9 months (standard error 7.8 months) in patients with positive PET/CT and 79.1 months (standard error 24.8 months) in patients with negative PET/CT. Mean PCa-specific survival time was 59.6 months (95% CI: 53.9 – 65.2 months) in patients with positive [11C]choline PET/CT and 77.9 months (95% CI: 75.9 – 79.9 months) in patients with negative [11C]choline PET/CT. At multivariable analyses, positive [11C]choline PET/CT scan (P 0.009), trigger prostate specific antigen level (PSA) (P 0.021), PSA doubling time (P 0.001), hormone resistance (P 0.001) and time to trigger PSA (P 0.040) were independednt predictors of survival. Patients with pathological tracer uptake in the skeleton had significantly (P 0.001) shorter survival than patients with pathological tracer uptake in lymph nodes and/or prostate bed, but without skeletal involvement. CONCLUSIONS: Positive [11C]choline PET/CT predicts shorter survival in PCa patients developing biochemical failure after radical prostatectomy. These results further support the use of [11C]choline PET/CT in restaging PCa patients with biochemical failure and suggest that this technique may be used for prognostic stratification.