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.

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We evaluated possible factors predicting testicular cancer in patients undergoing testis sparing surgery. Materials and Methods: We retrospectively analyzed the records of all patients who underwent testis sparing surgery for a small testicular mass at a total of 5 centers. All patients with 1 solitary lesion 2 cm or less on preoperative ultrasound were enrolled in the study. Testis sparing surgery consisted of tumor enucleation for frozen section examination. Immediate radical orchiectomy was performed in all cases of malignancy at frozen section examination but otherwise the testes were spared. Univariate and multivariate analysis were performed and ROC curves were produced to evaluate preoperative factors predicting testicular cancer. Results: Overall 147 patients were included in the study. No patient had elevated serum tumor markers. Overall 21 of the 147 men (14%) presented with testicular cancer. On multivariate analysis the preoperative ultrasound diameter of the lesion was a predictor of malignancy (OR 6.62, 95% CI 2.26e19.39, p[0.01). On ROC analysis lesion diameter had an AUC of 0.75 (95% CI 0.63e0.86, p[0.01) to predict testicular cancer. At the best cutoff of 0.85 the diameter of the lesion had 81% sensitivity, 58% specificity, 24% positive predictive value and 95% negative predictive value. Conclusions: Our study confirms that small testicular masses are often benign and do not always require radical orchiectomy. Preoperative ultrasound can assess lesion size and the smaller the nodule, the less likely that it is malignant. Therefore, we suggest a stepwise approach to small testicular masses, including tumorectomy, frozen section examination and radical orchiectomy or testis sparing surgery according to frozen section examination results.

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