Abstract
PurposeTo evaluate fluorine-18 fluorocholine (FCH) PET/CT for the detection of recurrent prostate cancer in relation to prostate-specific antigen (PSA) level.MethodsFCH PET/CT was performed in 50 patients with rising PSA levels at follow-up of primary treatment of prostate cancer (radical prostatectomy in 28, radiation therapy in 13, and brachytherapy in 9). PET detection rates were determined at various PSA thresholds and examined by receiver operating characteristic analysis.ResultsFindings consistent with recurrent prostate cancer were noted on FCH PET/CT in 31/50 (62 %) patients, with positive findings in 17/18 (94 %), and 11/13 (85 %), 2/7 (29 %), and 1/12 (8 %) patients with PSA >4, >2–4, >0.5–2, and ≤0.5 ng/mL, respectively. These findings were indicative of local/regional recurrence in 23 cases and systemic recurrence in 8 cases, with only a single route of recurrence (i.e., either hematogenous, lymphatic, or intraprostatic) in 84 % of PET scans with positive findings. Abnormal tumor activity was detected in 88 % of patients with a PSA level of 1.1 ng/mL or higher, and in only 6 % of patients with a PSA level below this threshold value.ConclusionFCH PET/CT may serve to identify the route of tumor progression in patients with recurrent prostate cancer; however, the likelihood of tumor detection may be related to the PSA level at the time of imaging.
Highlights
A rising serum prostate-specific antigen (PSA) level is often the first indicator of recurrent disease in patients with prostate cancer treated with radiation therapy (RT) or radical prostatectomy (RP)
FCH PET/CT was performed in 50 patients with rising PSA levels at follow-up of primary treatment of prostate cancer
Findings consistent with recurrent prostate cancer were noted on FCH PET/CT in 31/50 (62 %) patients, with positive findings in 17/18 (94 %), and 11/13 (85 %), 2/7 (29 %), and 1/12 (8 %) patients with PSA [4, [2–4, [0.5–2, and B0.5 ng/mL, respectively
Summary
A rising serum prostate-specific antigen (PSA) level is often the first indicator of recurrent disease in patients with prostate cancer treated with radiation therapy (RT) or radical prostatectomy (RP). Localizing recurrent tumors in these patients has proven to be a significant challenge when using conventional diagnostic imaging, when the PSA level has not yet risen substantially [3,4,5]. Patientindividualized treatment approaches for recurrent prostate cancer could be enhanced if tumor spread along local, lymphatic, and hematogenous routes are correctly identified shortly after a rise in PSA is detected. PET imaging using tracer analogs of choline has shown significant promise for detecting prostate cancer [8,9,10,11,12,13]. While there are some data on the performance of choline-based PET imaging for whole-body staging of prostate cancer, some uncertainty remains as to its diagnostic sensitivity in patients with low levels of PSA following RP, external
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