Androgen deprivation therapy influences the uptake of 11C-choline in patients with recurrent prostate cancer: the preliminary results of a sequential PET/CT study

Fuccio, Chiara; Schiavina, Riccardo; Castellucci, Paolo; Rubello, Domenico; Martorana, Giuseppe; Celli, Monica; Malizia, Claudio; Profitós, M. Barios; Marzola, Maria Cristina; Pettinato, Cinzia; Fanti, Stefano

doi:10.1007/s00259-011-1867-0

Cited by 64 publications

(24 citation statements)

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“…These results showed that PSA level and ADT were the only significant predictors of 18 F-FCH PET positivity. Our findings are in contrast to previously published data (24) indicating that choline uptake will be significantly reduced by ADT. This discrepancy may be related to disease aggressiveness or other factors such as advanced primary tumor stage in hormone-refractory prostate cancer patients.…”

Section: Discussioncontrasting

confidence: 57%

“…Nevertheless, tumor stage and PSA doubling time were not significant predictors. In a preliminary study, Fuccio et al (24) showed that ADT significantly reduces 11 C-choline uptake in androgen-sensitive prostate cancer patients. However, there are different aspects concerning the influence of ADT on choline PET/CT in hormone-refractory patients with biochemical recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…The PSA cutoff for the prediction of choline PET/CT positivity has been a subject of controversy (9,14,15,17,21,22). Additionally, the influence of androgen deprivation therapy (ADT) on choline uptake was evaluated in only a few studies with limited patient populations (23,24).…”

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confidence: 99%

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

et al. 2013

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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.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…For example, Fuccio et al found that ADT preceding PET/CT significantly decreases the detection capability due to a lower choline uptake in tumorous cells when androgen has been deprived (Fuccio et al 2011). Based on our current study, we conclude that hormonal treatment has no effect on the PET/CT detection ability.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of PET/CT regarding the detection of lymph node metastases in prostate cancer recurrence

et al. 2014

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BackgroundThe aim of the study is to assess the efficacy of choline PET/CT regarding the detection of lymph node (LN) metastases in recurrent prostate cancer (PCa).Methods49 patients with a biochemical recurrence of PCa (PSA >0.2 ng/ml) were included in the study. All patients were selected for further diagnostics with a choline-PET/CT. All patients underwent salvage extended lymphadenectomy. The PET/CT result and the histological findings were analyzed regarding the specificity and sensitivity and with respect to the localization of the metastases. The detection rate of LN metastases was analyzed with respect to interdependencies between the pre-PET/CT PSA-value as well as the role of prior ADT.Results41 out of 49 (83.6%) patients showed positive PET/CT results. Positive LNs were found in 27 out of 49 patients (55.1%). 48.9% of the PET-CT-findings proved true positive, 36.7% were found to be false positive. 8.1% proved true negative and 8.1% false negative. This results in a specificity of 22.7% and a sensitivity of 85.1%. Out of the true positive PET/CT scans, 61.9% were not congruent regarding the localization of positive LNs. In patients with PSA [greater than or equal to] 5 ng/ml, the sensitivity of the PET/CT result was 93.7%, while specificity was 0%. In 24 patients who underwent ADT prior to the PET/CT diagnostics, the sensitivity was 84.6% and specificity 9.0%.ConclusionsThe reliability of PET/CT imaging for detection of LN metastases is limited by a high false-positive rate. The influence of ADT further diminishes the PET/CT reliability. Sensitivity of the PET/CT is highest in patients with a PSA of [greater than or equal to] 5 ng/ml. Based on our results, we propose the following conclusions: 1. There is no well-established diagnostic alternative to Choline-PET/CT Scan. Therefore this method may continue to be performed in patients with BCR. 2. It is not sufficient to remove only those LNs that show up in the PET/CT. 3. Salvage extended lymphadenectomy should follow a predefined template (e.g. the “Kiel template”) and not just the PET/CT scan results.

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“…Fuccio et al investigated this issue by means of sequential 11 C-choline PET/CT in 14 patients with recurrent prostate cancer during follow-up after radical prostatectomy with rising PSA levels. 21 All patients had undergone at least two consecutive 11 C-choline PET/CT scans before and 6 months after ADT administration. The mean serum PSA level before ADT was 17.0 ± 44.1 ng/ml.…”

Section: Cholinementioning

confidence: 99%

PET Tracers Beyond FDG in Prostate Cancer

Schuster

Nanni

Fanti

2016

Seminars in Nuclear Medicine

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Conventional anatomic imaging with computed tomography (CT) and magnetic resonance imaging (MRI) has limitations in the evaluation of prostate cancer. Positron emission tomography (PET) is a powerful imaging technique which can be directed toward molecular targets as diverse as glucose metabolism, density of prostate specific membrane antigen (PSMA) receptors, and skeletal osteoblastic activity. While 2-deoxy-2-[18F]fluorodeoxyglucose (FDG) PET is the mainstay of molecular imaging, FDG has limitations in typically indolent prostate cancer. Yet, there are many useful and emerging PET tracers beyond FDG which provide added value. These include radiotracers interrogating prostate cancer via molecular mechanisms related to the biology of choline, acetate, amino acids, bombesin, dihydrotestosterone, among others. Choline is utilized for cell membrane synthesis and its metabolism is upregulated in prostate cancer. 11C-choline and 18F-choline are in wide clinical use outside the United States, and have proven most beneficial for detection of recurrent prostate cancer. 11C-acetate is an indirect biomarker of fatty acid synthesis which is also upregulated in prostate cancer. Imaging of prostate cancer with 11C-acetate is overall similar to the choline radiotracers yet is not as widely utilized. Upregulation of amino acid transport in prostate cancer provides the biologic basis for amino acid based radiotracers. Most recent progress has been made with the non-natural alicyclic amino acid analogue radiotracer anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid (FACBC or fluciclovine) also proven most useful for the detection of recurrent prostate cancer. Other emerging PET radiotracers for prostate cancer include the bombesin group directed to the gastrin releasing peptide receptor (GRPR), 16β-18F-fluoro-5α-dihydrotestosterone (FDHT) which binds to the androgen receptor, and those targeting the vasoactive intestinal polypeptide receptor 1 (VPAC-1) and urokinase plasminogen activator receptor (uPAR) which are also overexpressed in prostate cancer.

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Androgen deprivation therapy influences the uptake of 11C-choline in patients with recurrent prostate cancer: the preliminary results of a sequential PET/CT study

Abstract: These preliminary results suggest that ADT significantly reduces (11)C-choline uptake in androgen-sensitive PC patients.

Cited by 64 publications

References 24 publications

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

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

Sensitivity and specificity of PET/CT regarding the detection of lymph node metastases in prostate cancer recurrence

PET Tracers Beyond FDG in Prostate Cancer

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Androgen deprivation therapy influences the uptake of 11C-choline in patients with recurrent prostate cancer: the preliminary results of a sequential PET/CT study

Abstract: These preliminary results suggest that ADT significantly reduces (11)C-choline uptake in androgen-sensitive PC patients.

Cited by 64 publications

References 24 publications

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

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

Sensitivity and specificity of PET/CT regarding the detection of lymph node metastases in prostate cancer recurrence

PET Tracers Beyond FDG in Prostate Cancer

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

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