Correlation of ¹¹c-choline PET-CT with time to treatment and disease-specific survival in men with recurrent prostate cancer after radical prostatectomy.

Abstract

123 Background: Restaging with PET-CT in biochemical recurrent prostate cancer after prostatectomy shows a higher frequency of (false) negative cases compared to restaging after EBRT. It is uncertain if this reflects low volume of disease and/or low grade as biopsies fail to prove recurrent cancer in 50% of cases. We followed the clinical course of men with recurrent prostate cancer (PCa) after radical prostatectomy and investigated treatment and survival. PET-CT data were correlated with clinical data, PSA kinetics and disease specific and overall survival. We also studied relative survival comparing an age matched group from the Central Dutch Statistical Office (CBS). Methods: 64 patients underwent 11C-Choline PET-CT on PSA relapse. All patients were initially treated with radical prostectomy and reached PSA nadir of <0.1ng/mL. Recurrent disease was defined as PSA <0.4ng/mL after nadir. Patients were either treated with watchful waiting, adjuvant radiotherapy and/ or androgen deprivation therapy based on individual assesments by the treating urologists. Chi-square, log-rank and Mann-Whitney-U tests were used to study this population Results: The 64 patients had median PSA of 1.4ng/mL. Median follow-up period of patients was 50 (6–124) months. Ten patients died during the course of follow-up of which 5 due to metastasized PCa. No significant differences were seen in age, time to recurrence, total PSA at recurrence and PET-CT results. Patients with abnormal PET had higher PSAVel (median 3.09 ng/mL/yr vs 10.17, p= 0.002) and and shorter PSADT (med 4.83 mo vs 0.53, p= 0.016). Median time to treatment was significantly lower in the PET-CT negative group. Age of patients at death from the whole group did not differ from the age of death in an age matched group. Disease specific survival was significantly higher in the PET-CT negative group (p0.05). Conclusions: A negative 11C-Choline PET-CT correlated with a higher disease specific survival and a lower treatment rate. Overall survival of the group was equal to the age matched cohort. No significant financial relationships to disclose.

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

“…This is due to the fact that most studies were cross-sectional and had small sample size and limited follow-up. To the best of our knowledge, only Breeuwsma et al preliminary reported on this issue (31). In this study that included 64 patients, 10 patients died during follow-up, of which 5 patients died due to metastasized disease.…”

“…For this reason, the study was not powered to detect significant differences in PCa-specific survival. KaplanMeier curves did show shorter overall survival in patients with positive 11 C-choline, but median overall survival was not achieved (31). Bone scintigraphy and PET/CT with 18 F-FDG are currently considered in the nuclear medicine community less sensitive or less accurate than 11 C-choline PET/CT for restaging PCa patients after biochemical failure (1,7,10,32,33).…”

Prognostic value of metabolic parameters and clinical impact of 18F-fluorocholine PET/CT in biochemical recurrent prostate cancer

“…Two retrospective studies investigated the prognostic implications of this imaging method on overall and diseasefree survival, one using CCH in 195 patients with castrateresistant PC [28] and the other using CCH in 302 hormonenaive patients with PC [29]. Breeuwsma et al studied the correlation between the results of PET with CCH and disease-free survival in hormone-naive patients with recurrent PC after radical prostatectomy [30]. This retrospective study in 172 patients with biochemical recurrence of PC is the first study to our knowledge to look for prognostic factors corresponding to semiquantitative parameters derived from this imaging method.…”

Can serial FCH-PET/CT scans predict the response to treatments in castrate resistant prostate cancer?

“…[22] suggested that 11 C-Choline PET/CT might be a suitable technique to identify patients with different prognosis for potential stratification for salvage lymphadenectomy or radiotherapy in oncologic trials. Conversely, Breeuwsma et al [23] did not find any significant differences in prostate cancer-specific survival on the basis of 11 C-choline PET/CT results. In our opinion, and by sharing the results by De Giorgi et al [9,10], radiolabelled choline PET, either 11 C or 18 F, might also be useful for monitoring the response to new therapies (such as taxanes or new anti-hormonal agents).Therefore, providing an appropriate support for future clinical trials.…”