Clinical utility of ¹⁸F‐fluorocholine positron‐emission tomography/computed tomography (PET/CT) in biochemical relapse of prostate cancer after radical treatment: results of a multicentre study

Abstract

ObjectiveTo evaluate 18 F-fluorocholine positron-emission tomography (PET)/computed tomography (CT) in restaging patients with a history of prostate adenocarcinoma who have biochemical relapse after early radical treatment, and to correlate the technique's disease detection rate with a set of variables and clinical and pathological parameters. Patients and MethodsThis was a retrospective multicentre study that included 374 patients referred for choline-PET/CT who had biochemical relapse. In all, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow-up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline-PET/CT with qualitative [T stage, N stage, early radical prostatectomy (RP) vs other treatments, hormone therapy concomitant to choline-PET/CT] and quantitative [age, Gleason score, prostate-specific antigen (PSA) levels at diagnosis, PSA nadir, PSA level on the day of the choline-PET/CT (Trigger PSA) and PSA doubling time (PSADT)] variables. We analysed whether there were independent predictive factors associated with positive PET/CT results. ResultsCholine-PET/CT was positive in 111 of 233 patients (detection rate 47.6%) and negative in 122 (52.4%). Disease locations: prostate or prostate bed in 26 patients (23.4%); regional and/or distant lymph nodes in 52 (46.8%); and metastatic bone disease in 33 (29.7%). Positive findings were validated by: results from other imaging techniques in 35 patients (15.0%); at least 6 months of clinical follow-up in 136 (58.4%); treatment response in 24 (10.3%); histological analysis of lesions in 17 (7.3%); and follow-up plus imaging results in 21 (9.0%). The statistical analysis of qualitative variables, corresponding to patients' clinical characteristics, and the positive/negative final PET/CT results revealed that only whether or not early treatment with RP was done was statistically significant (P < 0.001), with the number of positive results higher in patients who did not undergo a RP. Among the quantitative variables, Gleason score, Trigger PSA and PSADT clearly differentiated the two patient groups (positive and negative choline-PET/CT: P = 0.010, P = 0.001 and P = 0.025, respectively). A Gleason score of <5 or ≥8 clearly differentiated positive from negative PET. Trigger PSA: mean of 8 ng/mL for positive PET/CT vs 2.8 ng/mL for negative PET/CT; PSADT: mean of 8 months for positive vs 12.6 months for negative. The optimal threshold values were: 3 ng/mL for Trigger PSA level and 6 months for PSADT (Youden index/receiver operating characteristic curve). Analysing these two variables together showed that PSADT was more conclusive in patients with lower Trigger PSA l...

11C-Choline Pet/Ct in the Detection of Prostate Cancer Relapse in Patients After Radical Treatment With Psa Level < 10 Ng/Ml

“…Though, PET/CT was able to detect PCa relapse in 43% (50/115) patients with low PSA values (< 2 ng/ml). According to data of other authors, PET/CT showed corresponding rates ranged from 19% to 55% [9,19,[21][22][23][24].…”

“…Rodado-Marina et al analyzed a group with comparable number of patients and reported 48% (111/233) [9]. In other studies, performed on larger and mixed groups of patients (both after RP and RT) as well, 11C/18F-Choline PET/CT results allowed to reveal PCa relapse in 62% (155/250), 65% (124/185), 74% (185/250) and 76% (129/170) [10][11][12][13].…”

“…(42/123) [9,21,27]. PET/CT allowed to detect isolated involvement of bone marrow in 27% of patients with bone metastases; Garcia et al report 39% [28].…”

Initial single-centre Canadian experience with 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/ CT) for biochemical recurrence in prostate cancer patients initially treated with curative intent

“…27,[29][30][31] We found the best threshold values to predict PET/CT positivity to be a trigger PSA of 2.6 ng/mL, PSAV of 2.0 ng/mL/year, and PSADT of 4.4 months. In comparison, Rodado-Marina et al reported a trigger PSA of 3.5 ng/mL (sensitivity 64%, specificity 76%) and PSADT of six months (sensitivity 58%, specificity 58%) while Cimitan et al reported a sensitivity of 79.5% and specificity of 67% for a trigger PSA of 2 ng/mL.…”

“…Our study shows a detection rate of 63.3% for recurrence after localized treatment of PCa, similar to previous studies. 27,28 A large number of the positive PET/CTs were validated using pre-established criteria.…”