Abstract
We aimed to investigate the role of positron emission computed tomography (PET/CT) with 18F-choline for predicting the outcome of metastatic castration-resistant prostate cancer (mCRPC) submitted to treatment with Radium-223 (223Ra-therapy). Clinical records of 20 mCRPC patients submitted to PET/CT with 18F-choline before 223Ra-therapy were retrospectively evaluated. The following PET-derived parameters were calculated: number of lesions, maximum and mean standardized uptake values (SUVmax, SUVmean), lean body mass corrected SUV peak (SULpeak), metabolic tumor volume (MATV), and total lesion activity (TLA). After 223Ra-therapy, all patients underwent regular follow-up until death. The predictive power of clinical and PET-derived parameters on overall survival (OS) was assessed by Kaplan–Meier analysis and the Cox proportional hazard method. All the patients showed 18F-choline-avid lesions at baseline PET/CT. Among the enrolled subjects, eleven (55%) completed all the six scheduled cycles of 223Ra-therapy; seven (35%) were responders according to imaging and biochemical parameters. Mean OS was 12.7 ± 1.4 months: by Kaplan–Meier analysis, number of lesions, PSA level and TLA were significantly correlated with OS. In multivariate Cox analysis, TLA remained the only significant predictor of survival (p = 0.003; hazard ratio = 7.6, 95% confidence interval = 1.9–29.5 months). 18F-choline PET may be useful for patients’ stratification before 223Ra-therapy. In particular, high metabolically active tumor burden (i.e., TLA) was predictive of poor outcome.
Highlights
Prostate cancer is a leading cause of death in developed countries
As secondary endpoint of the study, we evaluated the role of 18 F-choline PET/CT for the assessment of the response to treatment
PET/CT scan with F-choline is routinely utilized for the detection of prostate cancer recurrence, its use for the prognostication of patients submitted to 223
Summary
Prostate cancer is a leading cause of death in developed countries. In particular, the condition of hormone-refractory metastatic disease, termed as “castration-resistant prostate cancer” (CRPC), is characterized by poor prognosis, with a reported median overall survival after CRPC onset ranging9–30 months among patients without metastases and 9–13 months among patients with metastases (mCRPC) [1]. Other treatments have been implemented such as poly(ADP-ribose) polymerase inhibitors (e.g., olaparib), which were demonstrated to provide survival benefit in mCRPC patients bearing defects in DNA repair genes, and immunotherapy with sipuleucel-T, consisting of autologous peripheral blood mononuclear cells, pulsed ex vivo and incubated with a fusion protein (prostatic acid phosphatase) [6,7]. Prostate-specific membrane antigen (PSMA) has emerged as an effective molecular target for prostate cancer imaging and therapy, according to the so-called “theranostic” approach. In this regard, the radioligand PSMA-617 has been conjugated with the beta-emitting radioisotope lutetium-177 (177 Lu) for the radionuclide therapy of mCRPC with favorable response rates in the first clinical trials [8]
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