Impact of ¹⁸F-Choline PET/CT in Prostate Cancer Patients with Biochemical Recurrence: Influence of Androgen Deprivation Therapy and Correlation with PSA Kinetics

Abstract

We evaluated the potential of 18 F-fluoromethyldimethyl-2-hydroxyethyl-ammonium (FCH) PET/CT in the detection of recurrent disease or distant metastases and correlated its diagnostic accuracy with prostate-specific antigen (PSA) levels in prostate cancer patients with biochemical evidence of recurrence. Furthermore, the influences of androgen deprivation therapy (ADT) and its duration on 18 F-FCH PET were assessed in this study. Methods: This prospective study included 250 prostate cancer patients with PSA relapse who underwent 18 F-FCH PET/CT. At the time of 18 F-FCH PET/CT imaging, the mean PSA level was 46.9 6 314.7 ng/mL and 55.2% (138/250) of patients were receiving ADT. Overall, ADT was performed on 67.2% (168/250) of patients after initial treatment. Imaging was performed on an integrated PET/CT system. Acquisition started 1 min after intravenous injection of 18 F-FCH (4.07 MBq/kg of body weight) with dynamic PET images in the pelvic region during 8 min (1 min/frame) followed by a static semi-wholebody acquisition. The final diagnosis of positive PET lesions was based on histopathology or a consensus of clinical findings, additional imaging, or follow-up imaging modalities. Results: 18 F-FCH PET/CT was able to correctly detect malignant lesions in 74% (185/250) of patients but was negative in 26% (65/250). In 28% of patients, only 1 lesion was detected (69/250); from these, 65.2% (45 patients) had a local recurrence, 18.8% (13 patients) a single lymph node, and 15.9% (11 patients) a solitary bone metastasis. The sensitivity of the 18 F-FCH PET was significantly higher (P 5 0.001) in patients with ongoing ADT (85%; confidence interval, 80%-91%) than in patients without ADT (59.5%; confidence interval, 50%-69%). 18 F-FCH PET sensitivity was 77.5%, 80.7%, 85.2%, and 92.8% for the trigger PSA levels of more than 0.5, 1.0, 2.0, and 4.0 ng/mL, respectively. Scan sensitivity was 33% in patients with a trigger PSA level of less than 0.3 ng/mL and 77% in patients with a trigger PSA level of greater than 0.3 ng/mL, respectively (P 5 0.001). Using a binary logistic regression analysis model, we showed trigger PSA and ADT to be the only significant predictors of positive PET findings. Conclusion:18 F-FCH PET/CT proved its potential as a noninvasive 1-stop diagnostic modality enabling us to correctly detect occult disease in 74% of patients and to differentiate localized from systemic disease. In patients with biochemical recurrence, it also guides to an optimal treatment approach after initial treatment. Trigger PSA and ADT are the 2 significant predictors of 18 F-FCH-positive PET lesions. ADT seems not to impair 18 F-FCH uptake in hormone-refractory prostate cancer patients.

18F-choline PET/CT for early detection of metastases in biochemical recurrence following radical prostatectomy

“…Castelluci et al reported 11C--choline PET/CT scans indicating metastases in 23% of 605 patients with PSA < 2 ng/mL, and in 18% of 291 patients with PSA < 1.0 ng/mL [15]. This is slightly less than in our study, but almost 25% of the patients in their study received HT at the time of the PET/CT investigation, which is known to affect the sensitivity of choline PET/CT [22]. Also, their study population included more patients with Gleason Score 5--6, with a lower likelihood of metastatic recurrence [7].…”

Effect of miR-146a polymorphism on biochemical recurrence risk after radical prostatectomy in southern Chinese population

“…One-third of prostate cancer cases were at intermediate-risk (i.e., T1-T2; PSA <20 ng/ mL and GS <8) when diagnosed (Beheshti et al, 2013). These patients may exhibit great variability in outcome as 5-year PSA-based biochemical failure rates range from 9 to 44% following radical prostatectomy (Roberts and Han, 2009).…”

11C–Choline PET / CT in the detection of prostate cancer relapse in patients with rising PSA

“…Результаты предыдущих исследований по оценке возможностей ПЭТ / КТ с 11 С-холином в диагностике рецидива РПЖ свидетельствуют об успешном опреде-лении точной его локализации в 36-76 % случаев [17,18,[21][22][23][24][25][26].…”