Evaluation of [¹¹C]‐choline positron‐emission/computed tomography in patients with increasing prostate‐specific antigen levels after primary treatment for prostate cancer

Abstract

OBJECTIVE To evaluate [11C]‐choline positron‐emission tomography (PET)/computed tomography (CT) for detecting clinical recurrence after primary treatment for prostate cancer. PATIENTS AND METHODS In all, 50 patients with prostate cancer who had had initial therapy (radical prostatectomy in 40, external beam radiation in three and interstitial brachytherapy in seven) had PET/CT using [11C]‐choline in the presence of an increased or increasing prostate‐specific antigen (PSA) level. The mean (range) time to biochemical progression was 22 (2–136) months. Current PSA levels were determined in all patients at the time of examination. The results were correlated with the histopathology reports after targeted biopsy or surgery, and with the clinical follow‐up. RESULTS The mean (median, range) PSA level in patients with positive PET/CT was 3.62 (2.42, 0.5–13.1) ng/mL, and that in patients with a negative scan was 0.90 (0.95, 0.41–1.40) ng/mL. PET/CT was positive in seven of 13 patients with a PSA level of <1.5 ng/mL, and histology was positive in this group in nine. In 17 patients with PSA levels of 1.5–2.5 ng/mL PET/CT was positive in all and the histology was positive in 13; in 11 men with a PSA level of 2.5–5 ng/mL PET/CT was positive in all 11 and the histology was positive in 10; in nine men with PSA levels of >5 ng/mL PET/CT identified all as positive and the histology was positive in eight. The sensitivity at a PSA level of <2.5 ng/mL of PET/CT for detecting recurrence was 91% (95% confidence interval, 71–99%) with a specificity of 50% (16–84)%. CONCLUSION [11C]‐choline PET/CT seems to be useful for re‐staging prostate cancer after curative therapy and with increasing PSA levels; this was verified by histological examination. We recommend this method at PSA levels of <2.5 ng/mL.

Comparative analysis of multiparametric magnetic resonance and PET-CT in the management of local recurrence after radical prostatectomy for prostate cancer

“…In a single-centre retrospective study, Rinnab et al [30] analysed 50 consecutive patients with biochemical recurrence after primary therapy for PC (RP in 40 patients), using 11C choline PET-CT. The results were correlated with a histopathology examination.…”

Serum tumor markers and PET/CT imaging for tumor recurrence detection

“…The overall detection rate for PET was 59 %. A similar relationship 11 between PSA levels and C-choline PET/CT positivity was put to evidence by Rinnab et al [65] in a series of 50 patients. Castellucci et al [66] studied the relationship between 11 C-choline PET/CT detection rate and other PSA derivates in particular PSA kinetics (PSA velocity, PSA vel; PSA doubling time, PSAdt) in a series of 190 prostate carcinoma patients following radical prostatectomy (RP) who presented with a biochemical recurrence (mean 4.2 ng/mL; median 2.1 ng/mL).…”

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

“…39 Vários estudos têm avaliado a acuidade diagnóstica desta técnica no contexto de recidiva bioquímica de CaP, apresentando valores de sensibilidade muito variáveis, entre 43 e 95%. 5,7,10,12,14,24,[40][41][42][43] Um estudo recente demonstrou a elevada sensibilidade e o elevado valor preditivo negativo da PET/CT com FCH-18. Nele, um grupo de doentes em recidiva bioquímica, permaneceu em remissão completa durante 6,5 anos de seguimento, após a excisão de metástase ganglionar única identificada em PET/CT com FCH-F18.…”