Restaging Prostate Cancer Patients Research Articles

Multiparametric dynamic whole-body PSMA PET/CT using [68Ga]Ga-PSMA-11 and [18F]PSMA-1007

BackgroundRoutine prostate-specific membrane antigen (PSMA) positron emission tomography (PET) performed for primary staging or restaging of prostate cancer patients is usually done as a single static image acquisition 60 min after tracer administration. In this study, we employ dynamic whole-body (D-WB) PET imaging to compare the pharmacokinetics of [68Ga]Ga-PSMA-11 and [18F]PSMA-1007 in various tissues and lesions, and to assess whether Patlak parametric images are quantitative and improve lesion detection and image readability.MethodsTwenty male patients with prostate cancer were examined using a D-WB PSMA PET protocol. Ten patients were scanned with [68Ga]Ga-PSMA-11 and ten with [18F]PSMA-1007. Kinetic analyses were made using time-activity curves (TACs) extracted from organs (liver, spleen, bone, and muscle) and lesions. For each patient, three images were produced: SUV + Patlak parametric images (Ki and DV). All images were reviewed visually to compare lesion detection, image readability was quantified using target-to-background ratios (TBR), and Ki and DV values were compared.ResultsThe two PSMA tracers exhibited markedly different pharmacokinetics in organs: reversible for [68Ga]Ga-PSMA-11 and irreversible for [18F]PSMA-1007. For both tracers, lesions kinetics were best described by an irreversible model. All parametric images were of good visual quality using both radiotracers. In general, Ki images were characterized by reduced vascular signal and increased lesion TBR compared with SUV images. No additional malignant lesions were identified on the parametric images.ConclusionD-WB PET/CT is feasible for both PSMA tracers allowing for direct reconstruction of parametric Ki images. The use of multiparametric PSMA images increased TBR but did not lead to the detection of more lesions. For quantitative whole-body Ki imaging, [18F]PSMA-1007 should be preferred over [68Ga]Ga-PSMA-11 due to its irreversible kinetics in organs and lesions.

Comparison of [18F]PSMA-1007 with [68Ga]Ga-PSMA-11 PET/CT in Restaging of Prostate Cancer Patients with PSA Relapse.

Simple SummaryProstate cancer (PC) is one of the most common malignancies in men. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) hybrid imaging can help improve the diagnosis of recurrent PC, in addition to conventional methods such as computed tomography (CT) or magnetic resonance imaging alone. In order to further evaluate the importance of PSMA hybrid imaging, this study identified prostate-specific antigen (PSA) threshold levels for the detection of PSMA-positive lesions in patients with elevated PSA values after therapy. The thresholds were calculated for two different radiopharmaceuticals, PET/CT with [18F]PSMA-1007 and [68Ga]Ga-PSMA-11, and the results were then compared. In patients who had previously undergone prostatectomy, there was an advantage of PET/CT with [18F]PSMA-1007. Overall, however, the results of both methods were similar. The findings may help improve PC detectability in the future and are likely of considerable interest to clinicians by refining algorithms to help determine the clinical approach for the evaluation and treatment of patients with elevated PSA values after therapy.This study aimed to compare the diagnostic performance of [18F]PSMA-1007 positron emission tomography/computed tomography (PET/CT) (18F-PSMA) and [68Ga]Ga-PSMA-11 PET/CT (68Ga-PSMA) by identifying prostate-specific antigen (PSA) threshold levels for optimal detecting recurrent prostate cancer (PC) and to compare both methods. Retrospectively, the study included 264 patients. The performances of 18F-PSMA and 68Ga-PSMA in relation to the pre-scan PSA were assessed by receiver operating characteristic (ROC) curve. 18F-PSMA showed PC-lesions in 87.5% (112/128 patients), while 68Ga-PSMA identified them in 88.9% (121/136). For 18F-PSMA biochemical recurrent (BCR) patients treated with radical prostatectomy (78/128, patient group: F-RP), a PSA of 1.08 ng/mL was found to be the optimal cut-off level for predicting positive and negative scans (AUC = 0.821; 95%, CI: 0.710–0.932), while for prostatectomized 68Ga-PSMA BCR-patients (89/136, patient group: Ga-RP), the cut-off was 1.84 ng/mL (AUC = 0.588; 95%, CI: 0.410–0.766). In patients with PSA < 1.08 ng/mL (F-RP) 76.3% and <1.84 ng/mL (Ga-RP) 78.6% scans were positive, whereas patients with PSA ≥ 1.08 ng/mL (F-RP) or 1.84 ng/mL (Ga-RP) had positive scan results in 100% and 91.5% (p < 0.001/p = 0.085). The identified PSA thresholds for PSMA-mappable PC lesions in BCR-patients (RP) showed a better separation for 18F-PSMA with regard to the distinguishing of positive and negative PC-lesions compared to 68Ga-PSMA. However, the two PSMA PET/CT tracers gave similar overall findings.

A bicentric retrospective analysis of clinical utility of 18F-fluciclovine PET in biochemically recurrent prostate cancer following primary radiation therapy: is it helpful in patients with a PSA rise less than the Phoenix criteria?

18F-Fluciclovine PET imaging has been increasingly used in the restaging of prostate cancer patients with biochemical recurrence (BCR); however, its clinical utility in patients with low prostate-specific antigen (PSA) levels following primary radiation therapy has not been well-studied. This study aims to determine the detection rate and diagnostic accuracy of 18F-fluciclovine PET and the patterns of prostate cancer recurrence in patients with rising PSA after initial radiation therapy, particularly in patients with PSA levels below the accepted Phoenix definition of BCR (PSA nadir +2ng/mL). This retrospective study included patients from two tertiary institutions who underwent 18F-fluciclovine PET scans for elevated PSA level following initial external beam radiation therapy, brachytherapy, and/or proton therapy. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine the diagnostic accuracy of 18F-fluciclovine PET and associations of PSA kinetic parameters with 18F-fluciclovine PET outcome. One hundred patients were included in this study. The overall detection rate on a patient-level was 79% (79/100). 18F-Fluciclovine PET was positive in 62% (23/37) of cases with PSA below the Phoenix criteria. The positive predictive value of 18F-fluciclovine PET was 89% (95% CI: 80-94%). In patients with PSA below the Phoenix criteria, the PSA velocity had the highest predictive value of 18F-fluciclovine PET outcome. PSA doubling time (PSADT) and PSA velocity were associated with the presence of extra-pelvic metastatic disease. 18F-Fluciclovine PET can identify recurrent disease at low PSA level and PSA rise below accepted Phoenix criteria in patients with suspected BCR after primary radiation therapy, particularly in patients with low PSADT or high PSA velocity. In patients with low PSADT or high PSA velocity, there is an increased probability of extra-pelvic metastases. Therefore, these patients are more likely to benefit from PET/CT or PET/MRI than pelvic MRI alone.

Dual-Time Point [68Ga]Ga-PSMA-11 PET/CT Hybrid Imaging for Staging and Restaging of Prostate Cancer.

Simple SummaryEarly diagnosis and tumor characterization of prostate cancer (PCa) are important for accurate treatment. [68Ga]Ga-PSMA-11 PET/CT turns out to constitute a major step toward improved diagnostic procedures to detect primary, recurrent, and metastatic PCa. The aim of our study is to evaluate the effect of a second imaging modality for the staging and restaging of PCa by possibly detecting additional PCa lesions due to the well-known increase of PSMA uptake over time. There was a significant increase in tracer uptake on delayed images in comparison to early [68Ga]Ga-PSMA-11 PET/CT in our study, but the lesion positivity rate was comparable. However, in a few individual cases, additional delayed scans provided an information advantage in PCa lesion detection. The findings of our study are likely to be of major interest to clinicians as well as to researchers defining the algorithms that are necessary to implement this promising method with its specific tracer into clinical routine.Routine [68Ga]Ga-PSMA-11 PET/CT (one hour post-injection) has been shown to accurately detect prostate cancer (PCa) lesions. The goal of this study is to evaluate the benefit of a dual-time point imaging modality for the staging and restaging of PCa patients. Biphasic [68Ga]Ga-PSMA-11 PET/CT of 233 patients, who underwent early and late scans (one/three hours post-injection), were retrospectively studied. Tumor uptake and biphasic lesion detection for 215 biochemically recurrent patients previously treated for localized PCa (prostatectomized patients (P-P)/irradiated patients (P-I) and 18 patients suspected of having primary PCa (P-T) were separately evaluated. Late [68Ga]Ga-PSMA-11 PET/CT imaging detected 554 PCa lesions in 114 P-P patients, 187 PCa lesions in 33 P-I patients, and 47 PCa lesions in 13 P-T patients. Most patients (106+32 P-P/P-I, 13 P-T) showed no additional PCa lesions. However, 11 PSMA-avid lesions were only detected in delayed images, and 33 lesions were confirmed as malignant by a SUVmax increase. The mean SUVmax of pelvic lymph node metastases was 25% higher (p < 0.001) comparing early and late PET/CT. High positivity rates from routine [68Ga]Ga-PSMA-11 PET/CT for the staging and restaging of PCa patients were demonstrated. There was no decisive influence of additional late imaging with PCa lesion detection on therapeutic decisions. However, in a few individual cases, additional delayed scans provided an information advantage in PCa lesion detection due to higher tracer uptake and improved contrast.

Diagnostic Performance of [18F]Fluorocholine and [68Ga]Ga-PSMA PET/CT in Prostate Cancer: A Comparative Study

The current study endeavored to closely compare the detection rate of 68-Gallium labelled prostate-specific membrane antigen ([68Ga]Ga-PSMA) versus [18F]Fluorocholine in men with prostate cancer (PC), to investigate the benefits and pitfalls of each modality in the setting of various patient characteristics. We retrospectively analyzed 29 biopsy-proven PC patients in two categories, staging and restaging, who underwent both scans within a maximum of 30 days of each other. Variables including patient demographics, prostate specific antigen (PSA) level, Gleason score, clinical course, and following treatments were recorded. The number and location of suspicious lesions as well as uptake values were noted. A total of 148 suspicious lesions were detected, of which 70.9% (105/148) were concordantly visualized in both imaging modalities. [68Ga]Ga-PSMA positron emission tomography/computed tomography (PET/CT) revealed a higher number of metastatic lesions per patients (91% vs 78%). The mean of maximum standardized uptake value (SUV max) in concordant lesions was significantly higher in [68Ga]Ga-PSMA compared to [18F]Fluorocholine PET/CT (14.6 ± 8.44 vs. 6.9 ± 3.4, p = 0.001). Discordant lesions were detected by both modalities, but more frequently by [68Ga]Ga-PSMA PET/CT (20.3% in [68Ga]Ga-PSMA versus 8.8% by [18F]Fluorocholine PET/CT). In patients with PSA levels below 1.0 ng/mL and <2.0 ng/mL, [18F]Fluorocholine PET/CT detection rate was half (57% and 55%, respectively) that of [68Ga]Ga-PSMA PET/CT. Tumor, nodes and metastases (TNM) staging, and subsequently patient management, was only influenced in 4/29 patients (14%), particularly by [68Ga]Ga-PSMA PET/CT with PSA values under 0.5 ng/mL. [68Ga]Ga-PSMA PET/CT revealed superior diagnostic performance to [18F]Fluorocholine PET/CT in staging and restaging of PC patients, especially in cases with low PSA levels. However, in a few hormone resistant high-risk PC patients, [18F]Fluorocholine PET/CT may improve overall diagnostic accuracy.

The role of PSMA PET/CT imaging in restaging of prostate cancer patients with low prostate-specific antigen levels

Prostate-specific membrane antigen (PSMA) is increasingly being recognized as a novel target for the PET imaging of prostate cancer (PCa) and Ga-DKFZ-11 (Ga-PSMA) has been suggested as a novel tracer for detection of PCa relapses and metastases. The aim of this study was to evaluate the diagnostic value of PSMA PET/CT in the diagnosis of recurrent PCa with low prostate-specific antigen (PSA) levels. We carried out a retrospective analysis of patients who underwent PSMA PET/CT from November 2013 to December 2014 in our department. Among these patients, 50 out of 178 who had increasing PSA levels (<5 ng/ml) and did not have known metastasis were included in this study. Patients had an average PSA of 1.41 ng/ml. A total of 29 patients (58%) showed at least one positive lesion. PET positivity rates of 31% (n=4), 54% (n=13), and 88% (n=14) were observed in patients with a PSA level of less than 0.2, 0.2-2, and 2-5 ng/ml, respectively. A positive correlation was observed between positivity rate and Gleason scores and blood PSA levels. Verification was performed in 46 patients, with biopsy (n=3) and follow-up, and conventional imaging studies at the time of the PET/CT or during follow-up with a mean period of 10.6±3.3 months and ranged from 3.8 to 16.4 months. According to patient-based analysis of 46 cases, 57% of patients had true positive, 24% of patients had true negative, 2% of patients had false positive, an 18% of patients had false-negative findings. A sensitivity of 76.47% (95% confidence interval: 58.83-89.25%) and a specificity of 91.67% (95% confidence interval: 61.52-99.79%) were found. PET/CT with Ga-PSMA is a valuable tool for assessing recurrence of PCa with a high sensitivity in patients who have PSA levels between 0.2 and 5 ng/ml. In addition, this study suggests that PSMA PET/CT can be used in patients with very low (<0.2 ng/ml) but increasing PSA levels, which, in many cases, may influence further clinical management.

PET–CT with (68 Ga)Gallium-Labeled PSMA Ligand for the Diagnosis of Prostate Cancer: Clinical Applications and Protocols

The detection of lesions in the context of biochemical recurrence of prostate cancer is a major challenge for all imaging modalities. Recently, the prostate-specific membrane antigen (PSMA) is recognized as a novel target for the PET–CT (positron emission tomography–computed tomography) imaging of prostate cancer with the tracer 68Ga-PSMA (68Gallium-labelled PSMA), mainly in the detection of relapses and metastasis. PSMA PET–CT imaging shows high tracer uptake at the sites of primary tumor and lymph node, and bone metastasis in direct correlation with aggressiveness and Gleason scores. PSMA PET–CT seems to be a highly accurate imaging tool for restaging of prostate cancer patients with biochemical recurrence, and it proved to be clearly superior in detecting prostate cancer lesions at low PSA levels when compared to other methods.

PSMA PET/CT imaging and therapy

Prostate-specific membrane antigen (PSMA) is increasingly recognized as a novel target for the PET imaging of prostate cancer (PCa) and 68Ga-DKFZ-11 (68Ga- PSMA) has been suggested as a novel tracer for detection of PCa relapses and metastasis. First human studies of PSMA PET/CT imaging have demonstrated high tracer uptake at the sites of primary tumor and lymph node and bone metastasis in direct correlation with aggressiveness and Gleason scores. PSMA PET/CT seems to be a highly accurate imaging tool for restaging of prostate cancer patients with biochemical recurrence. PSMA PET/CT imaging may be used in order to develop a treatment strategy for recurrent disease even in patients with low PSA levels. As a theranostic approach its counterpart Lu-177 labelled ligands have a potential role for the treatment of castration resistant prostate cancer.

32nd International Austrian Winter Symposium : Zell am See, the Netherlands. 20-23 January 2016.

A1 68Ga-PSMA PET/CT in staging and restaging of Prostate Cancer Patients: comparative study with 18F-Choline PET/CT

Targeted salvage lymphadenectomy in patients treated with radical prostatectomy with biochemical recurrence: complete biochemical response without adjuvant therapy in patients with low volume lymph node recurrence over a long-term follow-up.

BackgroundCholine positron emission tomography/computed tomography (PET/CT) represents an option in restaging of prostate cancer patients with disease relapse after local treatment. The present study assess whether salvage resection of lymph node metastases detected on choline PET/CT imaging in prostate cancer patients with biochemical recurrence after radical prostatectomy can result in a long-term complete biochemical remission, without adjuvant therapy.MethodsWe analysed 13 patients with prostate specific antigen (PSA) recurrence (PSA median 1.64 ng/ml, range 0.5-9.55) after radical prostatectomy and suspicious lymph nodes (median 1; range 1–3) detected on [11C]choline and [18F]fluoroethylcholine PET/CT scans. An open salvage lymphadenectomy of positive lymph nodes in a PET/CT scan and nearby lymph nodes was carried out. We examined PSA outcome without adjuvant therapy; defined complete biochemical remission as PSA <0.01 ng/ml. Histological and PET/CT findings were compared.ResultsTen of 11 patients with histologically confirmed lymph node metastases showed a PSA response. Three of ten patients with single lymph node metastases had a complete biochemical remission (median follow-up 72 months, range 31.0-83). In five cases with single lymph node metastasis PSA decreased <0.02 ng/ml. Histologically confirmed 13 of 16 metastasis suspicious lymph nodes. No lymph node metastases were detected in two patients. All of the additionally removed 30 lymph nodes were correctly negative.ConclusionsThis is the first confirmation of a complete biochemical remission after PET/CT guided secondary resection of a single lymph node metastasis in prostate cancer patients with biochemical recurrence after radical prostatectomy, over the long-term (>6.5 years), without adjuvant therapy. In order to improve these promising results, longer-term studies with more patients are required.

False-Positive Result in 18F-Fluorocholine PET/CT Due to Incidental and Ectopic Parathyroid Hyperplasia

PET/CT with F-fluorocholine (a positron-labeled choline analog) is currently used as a diagnostic tool for restaging prostate cancer patients with increasing prostate-specific antigen. We present an unusual case of a false-positive result using F-fluorocholine PET/CT because of incidental and ectopic parathyroid hyperplasia.

Relationship between prostate-specific antigen kinetics and detection rate of radiolabelled choline PET/CT in restaging prostate cancer patients: a meta-analysis

The aim of the article was to systematically review published data about the relationship between prostate-specific antigen (PSA) kinetics, including PSA doubling time (PSAdt) and PSA velocity (PSAvel), and detection rate (DR) of positron emission tomography/computed tomography (PET/CT) using radiolabelled choline in restaging prostate cancer (PCa). A comprehensive literature search of studies published through July 2013 regarding the relationship between PSA kinetics and DR of radiolabelled choline PET/CT was carried out. Furthermore, a meta-analysis was performed in order to establish the DR of radiolabelled choline PET/CT using different cut-off values of PSAdt (≤ or >6 months) and PSAvel [>1 or ≤1 ng/(mL year) and >2 or ≤2 ng/(mL year)]. Moreover, a pooled analysis to establish whether PSAdt and PSAvel (using the abovementioned cut-off values) may predict positive PET/CT results was carried out. Fourteen articles were selected. The pooled DR of radiolabelled choline PET/CT in restaging PCa was 58% [95% confidence interval (CI) 55-60]. Most articles reported a relationship between PSA kinetics and DR of PET/CT. Pooled DR of radiolabelled choline PET/CT increased to 65% (95% CI 58-71) when PSAdt was ≤6 months and to 71% (95% CI 66-76) and 77% (95% CI 71-82) when PSAvel was >1 or >2 ng/(mL year), respectively. PSAdt ≤6 months and PSAvel >1 or >2 ng/(mL year) proved to be relevant factors in predicting the positive result of radiolabelled choline PET/CT. Due to the strong relationship between PSA kinetics and DR of radiolabelled choline PET/CT, beyond PSA values, PSAdt and PSAvel should be taken into account in the selection of PCa patients who should undergo radiolabelled choline PET/CT for restaging.

Role of 18F-choline PET/CT in suspicion of relapse following definitive radiotherapy for prostate cancer

The aims of the study were (a) to evaluate the diagnostic role, by means of positive detection rate (PDR), of ¹⁸F-choline (CH) positron emission tomography (PET)/CT in patients with prostate cancer treated with radiotherapy, with curative intent, and suspicion of relapse during follow-up, (b) to correlate the PDR with trigger prostate-specific antigen (PSA), (c) to investigate the possible influence of androgen deprivation therapy (ADT) at the time of scan on PDR and (d) to assess distribution of metastatic spread. ¹⁸F-CH PET/CT exams from 46 consecutive patients (mean age 71.3 years, range 51-84 years) with prostate cancer (mean Gleason score 6.4, range 5-8) previously treated by definitive radiotherapy and with suspicion of relapse with negative or inconclusive conventional imaging were retrospectively evaluated. Of the 46 patients, 12 were treated with brachytherapy and 34 with external beam radiation therapy. Twenty-three patients were under ADT at the time of the examination. Trigger PSA was measured within 1 month before the exam (mean value 6.5 ng/ml, range 1.1-49.4 ng/ml). Patients were subdivided into four groups according to their PSA level: 1.0 < PSA ≤ 2.0 ng/ml (11 patients), 2.0 < PSA ≤ 4.0 ng/ml (16 patients), 4.0 < PSA ≤ 6.0 ng/ml (9 patients) and PSA > 6.0 ng/ml (10 patients). Correlation between ADT and PDR was investigated as well as between PSA and distribution of metastatic spread. The overall PDR of ¹⁸F-CH PET/CT was 80.4% (37/46 patients), increasing with the increase of trigger PSA. PDR of ¹⁸F-CH PET/CT is not influenced by ADT (p = 0.710) even if PET performed under ADT demonstrated an overall higher PDR (82.6%). The majority of the patients (59%, 22/37 patients) showed local relapse only, confined to the prostatic bed; 22% of the PET/CT-positive patients (8/37 patients) showed distant relapse only (bone localizations in all of them), while the remaining 19% (7/37 patients) showed both local and distant (lymph node and bone) spread. ¹⁸F-CH PET/CT showed a high overall detection rate (80%), proportional to the trigger PSA (both for local and distant relapse) not influenced by ADT. ¹⁸F-CH PET/CT is proposed as a first-line imaging procedure in restaging prostate cancer patients primarily treated with radiotherapy.

Predictive factors of [18F]-Choline PET/CT in 170 patients with increasing PSA after primary radical treatment

The purpose of this study was to evaluate the potential usefulness of [18F]-Choline PET/CT in the restaging of prostate cancer patients, who presented a rising PSA. We evaluated 170 prostate cancer patients, previously radically treated, that were referred for restaging with [18F]-Choline PET/CT. A total of 129 patients (median PSA 4.29 ng/ml at relapse) showed one or more areas of high uptake on PET/CT scan, while 41 patients with a median PSA of 1.07 ng/ml at relapse showed negative PET/CT scans. No false negative was found, while 31 patients were identified as false positive. Specificity of Choline PET/CT in our series was 56.9 %, while sensibility was 100 %. At the time of restaging, a PSA value superior or equal to 1 ng/ml was found to be a statistically significant predictive factor of PET positivity, either at the univariate (p < 0.0001) and at the multivariate analysis (p < 0.0001). Based on our findings, [18F]-Choline PET/CT is confirmed as a useful diagnostic tool to detect early recurrence, in patients with increasing PSA after primary treatment. However, in case of a mild increase in PSA, positive results must be validated with other techniques, as specificity and positive predictive value of [18F]-Choline PET/CT decrease with the lower values of PSA.

Incidental Finding of Parathyroid Adenoma With 11C-Choline PET/CT

Positron emission tomography/computed tomography (PET/CT) with 11C-choline is an established diagnostic tool for restaging prostate cancer patients with biochemical failure after primary treatment. In the present case, 11C-choline PET/CT was performed in a prostate cancer patient with skeletal metastases, treated with hormonal therapy. In addition to the detection of pathologic uptake at prostate and vertebra, 11C-choline uptake occurred in the neck. The finding was suggestive for a parathyroid adenoma on subsequent ultrasound, then finally confirmed by parathyroid scintigraphy and histopathological analysis performed after hemithyroidectomy.

Role of 11C-choline PET/CT in the re-staging of prostate cancer patients with biochemical relapse and negative results at bone scintigraphy

Aimto evaluate the utility of 11C-choline PET/CT in prostate cancer (PC) patients who have demonstrated a biochemical recurrence and a negative bone scintigraphy (BS). Materials and methods123 consecutive PC patients (mean age 67.6 years; range 54–83) with a biochemical relapse (mean PSA value 3.3ng/mL; range 0.2–25.5) after radical prostatectomy (RP) were included in our retrospective study. Patients underwent a BS that resulted negative and a 11C-choline PET/CT within 4 months from BS (range: 1 day to 4 months; mean: 2.5 months). Validation of results was established by: (1) a positive biopsy, (2) a positive subsequent BS, CT or MR and (3) a normalization of 11C-choline uptake after systemic therapy or a progression of the disease. Results11C-choline PET/CT was positive in 42/123 patients (34.1%). 11C-choline PET/CT detected lesions in: bone (10 patients), lymph-nodes (20 patients), bone and lymph nodes (7 patients), bone and lung (1 patient), lymph-nodes and lung (1 patient), local relapse (3 patients). Overall, 11C-choline PET/CT showed a total of 30 unknown bone lesions in 18/123 (14.6%) patients. Conclusion11C-choline PET/CT showed a better sensitivity than BS in patients with biochemical relapse after RP: 11C-choline PET/CT detected unknown bone lesions in 18/123 (14.6%) patients.

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

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.

187 IS [11C]CHOLINE PET/CT RECOMMENDED FOR RESTAGING PROSTATE CANCER PATIENTS AFTER RADICAL PROSTATECTOMY WHEN PSA IS LOWER THAN 1 NG/ML?

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2012187 IS [11C]CHOLINE PET/CT RECOMMENDED FOR RESTAGING PROSTATE CANCER PATIENTS AFTER RADICAL PROSTATECTOMY WHEN PSA IS LOWER THAN 1 NG/ML? Manuela Tutolo, Alberto Briganti, Nazareno Suardi, Andrea Gallina, Firas Abdollah, Rita Garcia Parra, Maria Picchio, Giampiero Giovacchini, Luigi Gianolli, Maria Cristina Messa, Ettore Di Trapani, Giuseppe Zanni, Niccolò Maria Passoni, Nicola Fossati, Giorgio Guazzoni, Patrizio Rigatti, and Francesco Montorsi Manuela TutoloManuela Tutolo Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Nazareno SuardiNazareno Suardi Milan, Italy More articles by this author , Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Firas AbdollahFiras Abdollah Milan, Italy More articles by this author , Rita Garcia ParraRita Garcia Parra Milan, Italy More articles by this author , Maria PicchioMaria Picchio Milan, Italy More articles by this author , Giampiero GiovacchiniGiampiero Giovacchini Milan, Italy More articles by this author , Luigi GianolliLuigi Gianolli Milan, Italy More articles by this author , Maria Cristina MessaMaria Cristina Messa Milan, Italy More articles by this author , Ettore Di TrapaniEttore Di Trapani Milan, Italy More articles by this author , Giuseppe ZanniGiuseppe Zanni Milan, Italy More articles by this author , Niccolò Maria PassoniNiccolò Maria Passoni Milan, Italy More articles by this author , Nicola FossatiNicola Fossati Milan, Italy More articles by this author , Giorgio GuazzoniGiorgio Guazzoni Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.239AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES [11C]choline PET/CT is currently recommended in restaging prostate cancer (PCa) patients previously treated with radical prostatectomy (RP) when prostate-specific antigen (PSA) values are higher than 1 ng/mL. The role of clinical and pathological variables in patients with lower PSA values to detect early PC recurrences by [11C]choline PET/CT was investigated. METHODS A total of 72 patients (mean age: 66 years, range: 51-80 years), treated with RP for PCa, who showed during follow-up (FU) a mild increase (< 1 ng/mL) of PSA serum levels (mean PSA: 0,57 ng/mL, range: 0,22-0,99 ng/mL) were retrospectively evaluated. Inclusion criterion was previous RP treatment and biochemical failure, defined as at least two consecutive PSA measurements greater than 0,2 ng/mL. [11C]choline PET/CT findings were validated using histological and follow-up clinical and imaging criteria in all cases. In order to identify predictive factors of a positive [11C]choline PET/CT, Cox regression analyses was using the following variables: age, Gleason Score, TNM staging, time from RP to the biochemical relapse, anti-androgen therapy at the time of [11C]choline PET/CT scan, trigger PSA value, PSA doubling time (PSADT) and PSA velocity (PSAV). RESULTS [11C]choline PET/CT suggested the presence of recurrences in 17/72 patients (23,6%): 6/17 (35,3%) in prostatectomy bed; 6/17 (35,3%) at lymph nodal level and 5/17 (29,4%) in the skeleton. At Cox regression analyses performed in patients with PSA increase < 1 ng/mL, only advanced pathological stage and short PSADT were significant (P < 0.05) predictors of positive [11C]choline PET/CT. CONCLUSIONS [11C]choline PET/CT can be useful in patients with PSA < 1 ng/mL, reporting a detection rate of recurrent disease in 24% of patients. Patients with PSA increase < 1 ng/mL after radical prostatectomy may be referred to [11C]choline PET/CT when advanced pathological stage and short PSADT occur. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e78-e79 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuela Tutolo Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Nazareno Suardi Milan, Italy More articles by this author Andrea Gallina Milan, Italy More articles by this author Firas Abdollah Milan, Italy More articles by this author Rita Garcia Parra Milan, Italy More articles by this author Maria Picchio Milan, Italy More articles by this author Giampiero Giovacchini Milan, Italy More articles by this author Luigi Gianolli Milan, Italy More articles by this author Maria Cristina Messa Milan, Italy More articles by this author Ettore Di Trapani Milan, Italy More articles by this author Giuseppe Zanni Milan, Italy More articles by this author Niccolò Maria Passoni Milan, Italy More articles by this author Nicola Fossati Milan, Italy More articles by this author Giorgio Guazzoni Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

891 Is [11C]choline PET/CT recommended for restaging prostate cancer patients after radical prostatectomy when PSA is lower than 1 ng/ml?

891 Is [11C]choline PET/CT recommended for restaging prostate cancer patients after radical prostatectomy when PSA is lower than 1 ng/ml?

PET/CT for the diagnosis, staging and restaging of prostate cancer

Prostate cancer is one of the most frequent cancers in men and constitutes the third most common cause of cancer deaths. Early diagnosis of primary prostate cancer, accurate staging, as well as accurate restaging in the case of cancer recurrence after primary treatment, are important for delivering the appropriate therapy. In the last ten years, functional and molecular imaging by means of PET and PET/CT are increasingly being used for such indications. This article provides a radiolabeled tracer-based review of the diagnostic value of PET and PET/CT in primary and recurrent prostate cancer. [18F]FDG, [11C]acetate, [18F]fluoride, and [18F]- and [11C]choline are reviewed in this frame with an emphasis on the radiolabeled choline derivates. PET/CT with radioactively labeled choline derivates is a promising molecular imaging technique for restaging prostate cancer patients with biochemical recurrence after definite primary therapy. However, for the diagnosis of primary prostate cancer, choline PET/CT cannot ...