241 DETERMINATION OF THE ACCURACY OF FDG-PET/CT IN THE PRIMARY STAGING OF BIOLOGICAL HIGH RISK PROSTATE CANCERS BEFORE LOCAL THERAPIES: INCREASED UPTAKE ASSOCIATED WITH HIGHLY AGGRESSIVE TUMORS

Abstract

You have accessJournal of UrologyProstate Cancer: Staging (I)1 Apr 2013241 DETERMINATION OF THE ACCURACY OF FDG-PET/CT IN THE PRIMARY STAGING OF BIOLOGICAL HIGH RISK PROSTATE CANCERS BEFORE LOCAL THERAPIES: INCREASED UPTAKE ASSOCIATED WITH HIGHLY AGGRESSIVE TUMORS Annie-Claude Blouin, Goran Rimac, Frédéric Bouchard, Claude Lemay, Vincent Fradet, André Caron, Yves Fradet, Louis Lacombe, Thierry Dujardin, Rabi Tigert, Jean-Mathieu Beauregard, and Frédéric Pouliot Annie-Claude BlouinAnnie-Claude Blouin Québec, Canada More articles by this author , Goran RimacGoran Rimac Québec, Canada More articles by this author , Frédéric BouchardFrédéric Bouchard Québec, Canada More articles by this author , Claude LemayClaude Lemay Québec, Canada More articles by this author , Vincent FradetVincent Fradet Québec, Canada More articles by this author , André CaronAndré Caron Québec, Canada More articles by this author , Yves FradetYves Fradet Québec, Canada More articles by this author , Louis LacombeLouis Lacombe Québec, Canada More articles by this author , Thierry DujardinThierry Dujardin Québec, Canada More articles by this author , Rabi TigertRabi Tigert Québec, Canada More articles by this author , Jean-Mathieu BeauregardJean-Mathieu Beauregard Québec, Canada More articles by this author , and Frédéric PouliotFrédéric Pouliot Québec, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1621AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cancer staging with FDG-PET/CT is accurate for many cancers but not for prostate cancers (PCa) based on early studies on heterogeneous cohorts of patients. However, in more recent studies, FDG-PET/CT was shown to be as accurate as 18F-Choline-PET/CT in recurrent and metastatic PCa. Moreover, it was shown that glucose metabolism enzymes were overexpressed in high Gleason sum PCa. We therefore hypothesized that FDG-PET/CT might be useful in the initial staging of biological high risk PCa (Gleason ≥8) before local therapies. METHODS Last year, 54 patients with Gleason sum ≥8 at biopsy underwent a FDG-PET/CT and a bone scan as initial staging procedures. 41 patients then underwent radical prostatectomy (RP) and bilateral pelvic lymph node dissection, while 13 patients received androgen deprivation therapy (ADT) alone or a combination of ADT and radiation therapy. Increased FDG uptake for each organ was defined as our detection rate. RESULTS At biopsy, 73 and 27% of patients had Gleason sum 8 and 9, pre-operative PSA was 16 ng/mL (median = 7.5) and 34, 34, 26 and 6% of patients had clinical stages T1, T2, T3 or T4. Increased FDG uptake was found in the prostate, lymph nodes (LN) and bones of 44, 15 and 6% of patients. Bone scan was positive in the 3 patients that had bone FDG uptake. In the operated patients cohort, using RP pathological specimens, sensitivity, specificity, positive and negative predictive values were 27, 100, 100 and 78% for LN metastasis. On univariate analysis (RP group), higher clinical stage, pathological Gleason sum and pattern and the presence of perineural invasion were significantly associated with intraprostatic FDG uptake (all p < 0.037). Patients without FDG uptake in the prostate were downstaged to Gleason ≤ 7 in 72.4% of cases at RP (vs 18.4% for increased uptake, p=0.0001). None of the patients downstaged to Gleason 6(3+3) nor 7(3+4) at pathology had an increased FDG uptake in the prostate while 62,5 and 100% of patients with Gleason 8 or 9 did (p = 0.01). Moreover, FDG-PET/CT LN positivity was associated with higher pathological stage, Gleason sum, positive LN,LN density, and the presence of seminal vesicle invasion (all p < 0.044). CONCLUSIONS Our results suggest for the first time that FDG-PET/CT is highly specific for PCa metastasis and may identify intraprostatic pathological downstaging in biologically high risk patients. Therefore, we demonstrate a possible prognostic and staging role for FDG-PET/CT in high-risk prostate cancers imaged before primary therapies. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e99-e100 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Annie-Claude Blouin Québec, Canada More articles by this author Goran Rimac Québec, Canada More articles by this author Frédéric Bouchard Québec, Canada More articles by this author Claude Lemay Québec, Canada More articles by this author Vincent Fradet Québec, Canada More articles by this author André Caron Québec, Canada More articles by this author Yves Fradet Québec, Canada More articles by this author Louis Lacombe Québec, Canada More articles by this author Thierry Dujardin Québec, Canada More articles by this author Rabi Tigert Québec, Canada More articles by this author Jean-Mathieu Beauregard Québec, Canada More articles by this author Frédéric Pouliot Québec, Canada More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...