Detection of Recurrent Prostate Cancer After Radical Prostatectomy: Comparison of ¹¹C-Choline PET/CT with Pelvic Multiparametric MR Imaging with Endorectal Coil

Abstract

The aim of this study was to compare 11 C-choline PET/CT with pelvic multiparametric MR imaging for detection of recurrent prostate carcinoma in patients with suspected recurrence after radical prostatectomy and to identify an optimal imaging method to restage these patients. Methods: This was a retrospective, single-institution study of 115 prostatectomy patients with suspected tumor recurrence who underwent both 11 C-choline PET/CT and multiparametric MR imaging with endorectal coil. The reference standard included histopathology, treatment change, and imaging follow-up for determination of locally recurrent tumor, lymph node (LN) metastases, and skeletal metastases. Two nuclear medicine and 2 genitourinary radiologists independently and in a masked manner reviewed PET/ CT and multiparametric MR imaging, respectively. The reviewers assessed for local recurrence in the prostatectomy bed as well as LN and bone metastases, rating their diagnostic confidence with a 5-point scoring system for each location. Receiver-operatingcharacteristic analysis was used to compare the 2 modalities. Results: The standard of reference (either positive or negative) for the diagnosis of local recurrence and pelvic LN and bone metastases was met in 87, 70, and 95 patients, respectively. Documented local recurrence and pelvic LN and bone metastases was present in 61 of 87 (70.1%), 50 of 70 (71.4%), and 16 of 95 (16.8%) patients, respectively. Patient-based area under the receiver-operatingcharacteristic curves of multiparametric MR imaging versus PET/ CT for the diagnosis of local recurrence and pelvic LN and bone metastases were 0.909 versus 0.761 (P 5 0.0079), 0.812 versus 0.952 (P 5 0.0064), and 0.927 versus 0.898 (P 5 0.69), respectively. Among 61 patients with local recurrence, 32 patients (52.4%) were correctly diagnosed as having local recurrence by both multiparametric MR imaging and PET/CT, 22 (36.1%) were correctly diagnosed by multiparametric MR imaging only, 6 (9.8%) could not be diagnosed by either modality, and 1 (1.6%) was correctly diagnosed by PET/CT only. The patient-based sensitivity, specificity, and accuracy of multiparametric MR imaging for diagnosing local recurrence were 88.5% (54/61), 84.6% (22/26), and 87.4% (76/87) whereas those of PET/CT for detecting body LN or bone metastases were 92.3% (72/78), 100% (18/18), and 93.8% (90/96), respectively. Conclusion: Multiparametric MR imaging with endorectal coil is superior for the detection of local recurrence, PET/CT is superior for pelvic LN metastasis, and both were equally excellent for pelvic bone metastasis. 11 C-choline PET/CT and pelvic multiparametric MR imaging are complementary for restaging prostatectomy patients with suspected recurrent disease.

11C- or 18F-Choline PET/CT for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer

“…Souvatzoglou et al found 11 C-choline uptake in the prostatic bed in 7 of 37 patients (19%) who had PSA failure after RP and were candidates for salvage radiotherapy (RT) of the prostatic fossa (6). These data were substantially confirmed by Kitajima et al, who found a sensitivity of 54% and a specificity of 92% for 11 C-choline PET/CT in the detection of local relapse in 87 patients after RP (7).…”

“…Various studies have investigated the diagnostic accuracy of 11 C-choline PET/CT for detecting PCa recurrence and have reported different values for sensitivity and specificity (5,(7)(8)(9)11,12,14). These variations could be attributed to the heterogeneity of patient populations in terms of inclusion criteria (i.e., PSA level, staging, and presence or absence of androgen deprivation therapy [ADT]).…”

“…Similar results were reported by Schilling et al (9) and Rinnab et al (10), supporting the use of 11 C-choline PET/CT in patients with BR and suspected lymph node metastases. Kitajima et al compared 11 C-choline PET/CT results with multiparametric MRI results in 115 patients with BR after RP (7). They reported patientbased sensitivity, specificity, and accuracy of 90%, 100%, and 93%, respectively, for 11 C-choline PET/CT in the detection of lymph node recurrence; with MRI, sensitivity, specificity, and accuracy for pelvic nodal involvement were 64%, 85%, and 70%, respectively (7).…”

Serum levels of PSA, ALP, ICTP, and BSP in prostate cancer patients and the significance of ROC curve in the diagnosis of prostate cancer bone metastases

“…Compared to the bone scan, serum markers showed advantages in their reproducibility, non-invasiveness, and relatively low cost. Serum prostate specific antigen (PSA) level can predict the lesion range of prostate cancer; PSA and alkaline phosphatase (ALP) are important predictors for bone metastasis (Kitajima et al, 2014;Pasoglou et al, 2015); serum bone sialoprotein (BSP) levels reflect the process of bone resorption and bone cell activity; and bone resorption marker collagen type I pyridine crosslinking peptide (ICTP) indicates bone cell function and bone absorption rate that has certain diagnostic significance in bone metastases (Luna et al, 2015;Pasoglou et al, 2015). This study investigated serum PSA, ALP, BSP, and ICTP levels in prostate cancer patients and the significance of receiver operating characteristic (ROC) curve in the diagnosis of prostate cancer bone metastasis to provide the basis for early diagnosis and treatment of bone metastases.…”

PET/CT com Fluorocolina-F18 em Doentes com Carcinoma da Próstata em Recidiva Bioquímica

“…20 Nos trabalhos publicados são referidos valores variáveis de sensibilidade, especificidade, valores preditivos positivo e negativo, e acuidade diagnóstica. Apesar da disparidade dos números, a PET/CT com FCH-F18 é, provavelmente, a técnica imagiológica com melhores resultados no estadiamento/restadiamento do CaP, quer na identificação de metástases ganglionares, 21 quer na deteção de metástases esqueléticas intra-medulares. 22 Apresenta, ainda, bons resultados na detecção de doença oculta, com uma taxa de sucesso de 74%, e na distinção entre doença localizada e sistémica.…”