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

Abstract

PURPOSE: To investigate the clinical value of (18)F-fluorocholine PET/CT (CH-PET/CT) in treatment decisions in patients with recurrent prostate cancer (rPCA). METHODS: The study was a retrospective evaluation of 156 patients with rPCA and CH-PET/CT for restaging. Questionnaires for each examination were sent to the referring physicians 14-64 months after examination. Questions included information regarding initial extent of disease, curative first-line treatment, and the treatment plan before and after CH-PET/CT. Additionally, PSA values at diagnosis, after initial treatment, before CH-PET/CT and at the end of follow-up were also obtained from the questionnaires. RESULTS: Mean follow-up was 42 months. The mean Gleason score was 6.9 at initial diagnosis. Initial treatment was: radical prostatectomy in 110 patients, radiotherapy in 39, and combined prostatectomy and radiotherapy in 7. Median PSA values before CH-PET/CT and at the end of follow-up were 3.40 ng/ml and 0.91 ng/ml. PSA levels remained stable, decreased or were below measurable levels in 108 patients. PSA levels increased in 48 patients. In 75 of the 156 patients (48%) the treatment plan was changed due to the CH-PET/CT findings. In 33 patients the therapeutic plan was changed from palliative treatment to treatment with curative intent. In 15 patients treatment was changed from curative to palliative. In 8 patients treatment was changed from curative to another strategy and in 2 patients from one palliative strategy to another. In 17 patients the treatment plan was adapted. CONCLUSION: CH-PET/CT has an important impact on the therapeutic strategy in patients with rPCA and can help to determine an appropriate treatment. Results: Mean follow-up was 42 months; mean Gleason Score was 6.9 at initial diagnosis. Initial treatment was: Radical prostatectomy (n=110), radiotherapy (n=39), combined prostatectomy and radiotherapy (n=7). Median PSA values before CH-PET/CT and at end of follow-up were 3.40 ng/ml and 0.91 ng/ml. PSA levels remained stable, dropped or were below measurable levels in 108 patients. PSA levels rose in 48 patients. In 75/156 patients (48%) treatment plan changed due to findings in CH-PET/CT. In 33 patients the therapeutic modality changed from a palliative to a curative intended treatment. In 15 patients the therapeutic modality was altered from a curative towards a palliative setting. 8 patients had a change from one curative modality to another and 2 patients from one palliative modality to another. 17 patients had adaptations within their therapeutic modality. Conclusion:CH-PET/CT has an important impact on therapeutic strategy in patients with recurrent prostate cancer and can help to determine an appropriate treatment.

11C-Choline PET/CT Predicts Prostate Cancer–Specific Survival in Patients with Biochemical Failure During Androgen-Deprivation Therapy

“…Soyka et al did report change of management using PET/CT with 18 F-fluorocholine in 48% of PCa patients (30). However, in this study change of management was assessed retrospectively a minimum of 14 mo after PET/CT.…”

Initial single-centre Canadian experience with 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/ CT) for biochemical recurrence in prostate cancer patients initially treated with curative intent

“…16 Choline is an essential component of phospholipid membrane and demonstrates increased metabolism in PCa. 17 The limited short half-life of 11C-choline (20.3 [23][24][25] The primary objective of this study was to determine predictive factors (patient and PSA characteristics) for 18F-FCH PET/CT positivity in patients with biochemical failure after local treatment for PCa with curative intent. Secondary objectives were to evaluate the impact of PET/CT on patient management and to compare its value to standard imaging techniques.…”

PET/CT imaging and the oligometastatic prostate cancer patient: an opportunity for a curative approach with high-dose radiotherapy?

“…Such a low PSA level is limiting factor for the detection of the suspected relapse site(s) even with choline or acetate tracers. In a recent study in 156 patients with recurrent prostate cancer after surgery or radiotherapy, PSA levels tended to be significantly lower in patients with a negative PET/CT choline study (median PSA 1.2 ng/ml, range 0.1 -30.3 ng/ml) than in those with a positive scan (median PSA 4.5 ng/ml, range 0.15 -296.61 ng/ml) [15]. Scattoni et al found a relatively low sensitivity of 64 % for nodal metastases with 11 C-choline PET/CT imaging in patients with biochemical progression after prostatectomy [16].…”