Histological verification of ¹¹C‐choline‐positron emission/computed tomography‐positive lymph nodes in patients with biochemical failure after treatment for localized prostate cancer

Abstract

OBJECTIVES To evaluate the potential of 11C‐choline‐positron emission tomography (PET)/computed tomography (CT) for planning surgery in patients with prostate cancer and prostate‐specific antigen (PSA) relapse after treatment with curative intent. PATIENTS AND METHODS We retrospectively reviewed the charts of 10 patients with PSA recurrence after either external beam radiation (two) or radical retropubic prostatectomy (eight) for prostate cancer, and who had a laparoscopic lymphadenectomy for suspicious lymph nodes detected on 11C‐choline‐PET/CT. The histological results and PET/CT findings were compared. RESULTS In all, 22 suspicious lymph nodes were found on PET/CT, and 14 on conventional CT or magnetic resonance imaging. Comparing the conventional imaging showed concordance in 13 lymph nodes. Three of the 10 patients had no metastatic lymph node disease on definitive histology. The mean (sd) PSA level for these patients was 1.0 (0.4) ng/mL, whereas that in patients with lymph node metastases was 15.1 (9.2) ng/mL (statistically significant difference, P < 0.05). The positive predictive value was seven of 10. All of the patients initially regressed, with PSA increases after lymphadenectomy. Two of the patients are being managed by watchful waiting, two had radiotherapy of the prostate fossa and two had chemotherapy with docetaxel. Four patients were treated by hormone‐deprivation therapy. After a mean (sd) follow up of 11 (7) months, one patient died, one has PSA progression, but none of those with negative histology has clinical signs of local recurrence. CONCLUSIONS 11C‐choline‐PET is a valuable tool for detecting recurrent prostate cancer, but the limited positive predictive value should lead to a critical interpretation of the results.

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

“…Using a per-lesion analysis, they found sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 64%, 90%, 86%, 72%, and 77%, respectively, for 11 C-choline PET/CT (8). 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).…”

“…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]).…”

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

“…Histologic confirmation has been obtained in no more than 15% of patients in most studies, whereas clinical and imaging criteria have been applied with variable methodologic consistency (1,2,(5)(6)(7)(8)10,14). False-positives are a concern because increased 11 C-choline uptake is not specific for carcinogenesis (15,16). Accuracy assessment will be particularly important for early restaging of disease and to monitor response to therapy.…”

Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges

“…On a nodal site-based analysis, it was estimated that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 11 C-choline PET/CT was 64%, 90%, 86%, 72%, and 77%, respectively. However, Schilling cautioned a limited positive predictive value of 11 C-choline PET/CT, as 3 of 10 patients deemed to have pelvic nodal metastases on 11 Ccholine PET/CT turned out no malignancy on pathology (53). Also, a recent study raised some doubt over the sensitivity of PET in the clinical setting of low PSA levels.…”