Prognostic Value of 18F-Choline PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Radium-223

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.

The prognostic power of inflammatory indices and clinical factors in metastatic castration-resistant prostate cancer patients treated with radium-223 (BIO-Ra study)

“…On the other hand, many studies already showed the prognostic value of circulating PSA and ALP at baseline, as biochemical indicators of the tumor extent [28,[31][32][33][34][35][36][37][38]. This is coherent with the unfavorable prognosis observed in patients with massive bone metastases (> 20) at the bone scan or high tumor burden assessed with more sophisticated quantification approaches [32,[39][40][41][42][43].…”

Optimal Sequencing and Predictive Biomarkers in Patients with Advanced Prostate Cancer

“…As previously mentioned, data from the TheraP and VISION trials support the notion that patients with significant PSMA-PET uptake are those expected to derive the greatest benefit from Lu-PSMA [ 27 , 68 ]. Some studies suggest that FDG- and choline-PET can adequately identify patients who better respond to treatment with ARSi and radium-223 in the mCRPC setting [ 161 , 162 , 163 ]. However, prospective studies are warranted to determine that the early identification of response/progression—not detected by standard imaging—is clinically useful and could affect the prognosis of patients.…”

PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature

“…[ 18 F]Choline and [ 68 Ga]PSMA-11 PET/CT as gatekeepers for the treatment of metastatic PCa with Radium 223 were assessed in three papers. The groups of Filippi [ 47 ] and Garcia Vicente [ 48 ] assessed 11 and 40 patients, retrospectively, who underwent PET/CT with [ 18 F]Choline before [ 223 Ra]dichloride treatment. They stated that the presence of extra-osseous disease at PET/CT was correlated with a poor outcome and also a high SUV max (in at least five sites).…”