Detection of Pelvic Lymph Node Metastases in Patients With Clinically Localized Prostate Cancer: Comparison of [ ¹⁸ F]Fluorocholine Positron Emission Tomography-Computerized Tomography and Laparoscopic Radioisotope Guided Sentinel Lymph Node Dissection

Abstract

Extended pelvic lymph node dissection reveals a higher number of lymph node metastases as described for obturator fossa dissection only. [18F]fluorocholine combined in-line positron emission tomography-computerized tomography is not useful in searching for occult lymph node metastases in clinically localized prostate cancer. Sentinel guided pelvic lymph node dissection allows the detection of even small lymph node metastases. The accuracy of sentinel pelvic lymph node dissection is comparable to that of extended pelvic lymph node dissection when the limitations of the method are taken into consideration.

18F-fluorocholine for prostate cancer imaging: a systematic review of the literature

“…Dynamic acquisition over the pelvis followed by a whole-body PET or PET/CT static acquisition including the pelvis has been proposed as allowing visualization of pelvic disease without interference from bladder uptake (dynamic imaging) while allowing maximum sensitivity for distant disease (delayed whole-body PET or PET/CT). 20,21,24,34,35,37,38,42,57 Early time points for imaging (0-15 min post-intravenous injection) and/or delayed imaging time points (30,40,45,60, 90-120 and 65-200 min post-intravenous injection) have been also described in the published literature. 22,23,[27][28][29][30][31][32][33]36,39,40,41,[43][44][45][46][47][48][49][50][51][52][54][55][56] 34 16…”

“…Seven studies detailing the radiosynthesis of 18 F-FCH, preclinical and early clinical dosimetry and biodistribution in humans were identified. [20][21][22][23][24][25][26] Clinical studies included six articles for evaluation of local disease, [27][28][29][30][31][32] five articles for evaluation of nodal disease, 30,[33][34][35][36] six articles for bone metastases, including evaluation of treatment response, 30,34,[37][38][39][40] 12 articles for biochemical recurrence 34,[36][37][38][40][41][42][43][44][45][46][47] and two articles evaluating 18 F-FCH in castrate-resistant patients. 39,48 Seven studies evaluated 18 F-FCH for defining intra-prostatic lesions or limited lymph node recurrence for dose-escalated radiotherapy.…”

“…32 Similarly, among 20 patients with persistently elevated PSA and repeated negative prostate biopsy, Igerc et al 31 noted 18 F-FCH focal uptake in 13/20 patients, but F-FCH PET/CT was positive, while sentinel lymph node detection was falsely negative. 35 Husarik et al 36 also noted a low sensitivity for nodal detection (20%) among 43 PCa men evaluated preoperatively. In seven intermediate-and high-risk PCa patients, Beauregard et al 34 noted a higher sensitivity for 18 F-FCH PET/CT (100%) compared with 18 F-FDG PET/CT (75%) and diagnostic CT (50%) for detection of extra-pelvic nodal metastases; 18 F-FCH and 18 F-FDG had a similar 63% sensitivity for detection of pelvic lymph node metastases vs 25% for diagnostic CT.…”

“…For small volume nodal disease, sentinel lymph node-guided lymph node dissection seems to have the highest sensitivity and specificity. 35 Distant bone disease. A unique advantage of 18 F-FCH PET/CT over other staging modalities is the ability to combine whole-body imaging with pelvic imaging to assess for distant metastases in a single session.…”

Current status of choline‐PET and prostate cancer

“…4,[11][12][13][14][15] A choline-PET scan showing nodal uptake is of clinical value, but a negative scan does not rule out occult nodal involvement, particularly for small deposits (<5mm).…”