Influence of Trigger PSA and PSA Kinetics on ¹¹C-Choline PET/CT Detection Rate in Patients with Biochemical Relapse After Radical Prostatectomy

Abstract

The purpose of this study was to investigate the effect of total prostate-specific antigen (PSA) at the time of 11 C-choline PET/ CT (trigger PSA), PSA velocity (PSAvel), and PSA doubling time (PSAdt) on 11 C-choline PET/CT detection rate in patients treated with radical prostatectomy for prostate cancer, who showed biochemical failure during follow-up. Methods: A total of 190 patients treated with radical prostatectomy for prostate cancer who showed an increase in PSA (mean, 4.2; median, 2.1; range, 0.2-25.4 ng/mL) were retrospectively enrolled. All patients were studied with 11 C-choline PET/CT. Patients were grouped according to trigger PSA (PSA # 1 ng/mL, 1 , PSA # 2 ng/mL, 2 , PSA # 5 ng/mL, and PSA . 5 ng/mL). In 106 patients, data were available for calculation of PSAvel and PSAdt. Logistic regression analysis was used to determine whether there was a relationship between PSA levels and PSA kinetics and the rate of detection of relapse using PET. Results: 11 C-choline PET/CT detected disease relapse in 74 of 190 patients (38.9%). The detection rate of 11 C-choline PET/CT was 19%, 25%, 41%, and 67% in the 4 subgroups-PSA # 1 ng/mL (51 patients), 1 , PSA # 2 ng/mL (39 patients), 2 , PSA # 5 ng/mL (51 patients), and PSA . 5 ng/mL (49 patients)-respectively. Trigger PSA values were statistically different between PET-positive patients (median PSA, 4.0 ng/mL) and PET-negative patients (median PSA, 1.4 ng/mL) (P 5 0.0001). Receiver-operating-characteristic analysis showed an optimal cutoff point for trigger PSA of 2.43 ng/mL (area under the curve, 0.76). In 106 patients, PSAdt and PSAvel values were statistically different between patients with PET-positive and -negative scan findings (P 5 0.04 and P 5 0.03). The 11 C-choline PET/CT detection rate was 12%, 34%, 42%, and 70%, respectively, in patients with PSAvel , 1 ng/mL/y (33 patients), 1 , PSAvel # 2 ng/mL/y (26 patients), 2 , PSAvel # 5 ng/mL/y (19 patients), and PSAvel . 5 ng/mL/y (28 patients). The 11 C-choline PET/CT detection rate was 20%, 40%, 48%, and 60%, respectively, in patients with PSAdt . 6 mo (45 patients), 4 , PSAdt # 6 mo (20 patients), 2 , PSAdt # 4 mo (31 patients), and PSAdt # 2 mo (10 patients). There was no statistical difference between PET-positive and -negative scan detection rates according to the Gleason score, pT and N status, patient age, or duration between surgery and biochemical relapse. Trigger PSA and PSAvel were found to be independent predictive factors for a PET-positive result (P 5 0.002; P 5 0.04) and PSAdt was found to be an independent factor only in patients with trigger PSA less than 2 ng/mL (P 5 0.05) using multivariate analysis. Conclusion: The 11 C-choline PET/CT detection rate is influenced by trigger PSA, PSAdt, and PSAvel. This finding could be used to improve the selection of patients for scanning by reducing the number of false-negative scans and increasing the detection rate of disease in patients with early relapse and potentially curative disease.

Evaluation of Hybrid 68Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy

“…Thus, if 68 Ga-PSMA ligand PET/CT were used in that preselected setting, the detection rate would potentially be different. Similarly to choline derivates, our results state a higher detection rate in patients with a higher PSAvel, albeit the P value of 0.0532 could be designed as borderline from a purist statistical point of view (3,32,35). Nevertheless, 68 Ga-PSMA ligand PET/CT offers a high rate of positive findings also in patients with low changes in PSA kinetics, with a detection rate of 81.8% compared with 12% for 11 C-choline at a PSAvel of 1 ng/mL/Y (35).…”

“…Similarly to choline derivates, our results state a higher detection rate in patients with a higher PSAvel, albeit the P value of 0.0532 could be designed as borderline from a purist statistical point of view (3,32,35). Nevertheless, 68 Ga-PSMA ligand PET/CT offers a high rate of positive findings also in patients with low changes in PSA kinetics, with a detection rate of 81.8% compared with 12% for 11 C-choline at a PSAvel of 1 ng/mL/Y (35). Notably, our data show no clear trend toward higher detection rates with a decreasing PSAdt, compared with reports for 11 C-and 18 F-choline (32,35).…”

“…Nevertheless, 68 Ga-PSMA ligand PET/CT offers a high rate of positive findings also in patients with low changes in PSA kinetics, with a detection rate of 81.8% compared with 12% for 11 C-choline at a PSAvel of 1 ng/mL/Y (35). Notably, our data show no clear trend toward higher detection rates with a decreasing PSAdt, compared with reports for 11 C-and 18 F-choline (32,35). However, especially at a low PSA value PSAdt is more susceptible to slight changes and thus not optimally suited in this patient collective.…”

Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer

“…Even though the exact role of the examination is still being discussed it seems that CH-PET/CT starts playing a role in the management of patients with a biochemical relapse [10] [11]. Several studies have demonstrated that CH-PET/CT either labeled with C-11 [12] [13] or with F-18 [14] [15] can detect tumor recurrence at PSA levels of above 2ng/ml giving the clinicians the opportunity of a curative intended salvage procedure at an early time-point of the recurrence [12][13][14][15].…”

Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges

“…Rinnab reported that 11 C-choline PET/CT had a sensitivity of 89% and specificity of 40% for patients with post-RP PSA levels ＜2.5 ng/mL (50). Castelluci reported that PSA level, PSA velocity and PSA doubling time were predictive factors for the outcome of 11 C-choline PET/CT for patients with post-RP PSA relapse (51). Scattoni, in a series of 21 patients with post-RP PSA relapse (median PSA: 1.98 ng/mL), correlated the outcome of 11 C-choline PET/CT for the detection of lymph node metastases with pelvic +/-retroperitoneal lymph node dissection (52).…”