Abstract
BackgroundThe aim of this study was to determine whether lymph node metastasis on pre-treatment 18F-choline PET/CT is an independent prognostic factor for biochemical recurrence (BCR), skeletal metastasis, and cancer specific mortality (CSM), after radical local treatment (radical prostatectomy and/or radiotherapy) in men with high-risk prostate cancer. Medical records were reviewed for men with newly diagnosed high-risk prostate cancer who had pre-treatment 18F-choline positron emission tomography fused with computed tomography (PET/CT) scan for primary metastasis staging.ResultsOf 174 eligible men, 124 met the criteria for inclusion. The PET/CT scan was negative for metastasis in 97 (78%) men, inconclusive in 15 (12%), and positive in 12 (10%). The men with a positive PET/CT scan had significantly shorter time to BCR (p = 0.02), time to skeletal metastasis (p = 0.002), and time to prostate cancer specific death (p < 0.001). On multivariable Cox regression analysis, including also tumour stage, Gleason score, and PSA, a non-negative PET/CT scan was the only significant covariate for time to BCR (HR 2.6, 95% CI 1.3–5.5) and time to skeletal metastasis (HR 2.7, 95% CI 1.3–5.9).ConclusionsIn men with a newly diagnosed high-risk prostate cancer and a negative or inconclusive bone scan, 18F-choline uptake on PET/CT suggestive metastasis was associated with recurrence, progression to distant metastasis, and prostate cancer death. This strongly indicates that the choline uptakes represented metastasis and not false positive findings.
Highlights
The aim of this study was to determine whether lymph node metastasis on pre-treatment 18F-choline positron emission tomography fused with computed tomography (PET/CT) is an independent prognostic factor for biochemical recurrence (BCR), skeletal metastasis, and cancer specific mortality (CSM), after radical local treatment in men with high-risk prostate cancer
Positron emission tomography fused with computed tomography (PET/CT) with 18F-choline as tracer has been evaluated in several studies and shown to accurately detect prostate cancer metastasis (Evangelista et al 2013)
Kjölhede et al European Journal of Hybrid Imaging (2018) 2:16 have previously reported on 18F-choline PET/CT for primary staging of high-risk prostate cancer (Kjölhede et al 2012, 2014, 2017): 18F-choline PET/CT indicated metastasis in 20–39% of men with high-risk prostate cancer, and the specificity of findings of regional lymph node metastasis was high at 92%
Summary
The aim of this study was to determine whether lymph node metastasis on pre-treatment 18F-choline PET/CT is an independent prognostic factor for biochemical recurrence (BCR), skeletal metastasis, and cancer specific mortality (CSM), after radical local treatment (radical prostatectomy and/or radiotherapy) in men with high-risk prostate cancer. An alternative to histopathological verification is to determine whether the men with suspicious metastasis on 18F-choline PET/CT have a worse prognosis in terms of biochemical recurrence (BCR), skeletal metastasis, and prostate cancer-specific mortality (CSM). This has been done with positive results in the setting of BCR after radical prostatectomy (Giovacchini et al 2013, 2015; Colombié et al 2015; Zattoni et al 2017), but not for primary staging at the time of diagnosis
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