¹¹C-Acetate PET/CT Before Radical Prostatectomy: Nodal Staging and Treatment Failure Prediction

Abstract

Despite early detection programs, many patients with prostate cancer present with intermediate- or high-risk disease. We prospectively investigated whether 11C-acetate PET/CT predicts lymph-node (LN) metastasis and treatment failure in men planned for radical prostatectomy. Methods 107 men with intermediate-or-high-risk localized prostate cancer with negative conventional imaging underwent PET/CT with 11C-acetate. Five underwent LN staging only and 102 LN staging and prostatectomy. PET/CT findings were correlated with pathologic nodal status. Treatment-failure-free survival (TFFS) was estimated by Kaplan-Meier method. The ability of PET/CT to predict outcomes was evaluated by multivariate Cox proportional hazards analysis. Results PET/CT was positive for pelvic LN or distant metastasis in 36 of 107 patients (33.6%). LN metastasis was present histopathologically in 25 (23.4%). The sensitivity, specificity, positive- and negative-predictive values of PET/CT for detecting LN metastasis were 68.0%, 78.1%, 48.6% and 88.9% respectively. 64 patients failed: 25 with metastasis, 17 with persistent post-prostatectomy prostate specific antigen (PSA) >0.20 ng/mL, and 22 with biochemical recurrence (PSA >0.20 ng/mL after nadir) during follow-up for a median of 44.0 months. TFFS was worse in PET-positive than in PET-negative patients (p<0.0001) and in those with false-positive versus true-negative scans (p<0.01), suggesting that PET may have demonstrated nodal disease not removed surgically or identified pathologically. PET positivity independently predicted failure in preoperative (hazard ratio=3.26, p<0.0001) and postoperative (HR=3.07, p=0.0001) multivariate models. Conclusion In patients planned for or completing prostatectomy, 11C-acetate-PET/CT detects LN metastasis not identified by conventional imaging and independently predicts TTFS.

Comparison of meta-analyses among elastosonography (ES) and positron emission tomography/computed tomography (PET/CT) imaging techniques in the application of prostate cancer diagnosis

“…In the process of recognizing and selecting associated studies with 11C-choline PET/CT [5,[8][9][10], 18F-FCH PET/ CT [20,44,[49][50][51][52][53][54][55][56][57][58][59][60][61], 11C-acetate PET/CT [7,13,14,62,63], 18F-FDG PET/CT [64][65][66][67][68], TRTE [11,12,[69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88], and SWE [3,…”

Influence of Four Radiotracers in PET/CT on Diagnostic Accuracy for Prostate Cancer: A Bivariate Random-Effects Meta-Analysis

“…In total, there were 3,743 patients as the case group and 3,586 matched healthy people as the control group. All included studies were published between 2005 and 2015 (11C-choline: n = 31 , 18F-FCH: n = 15 [17,[55][56][57][58][59][60][61][62][63][64][65][66][67][68], 11C-acetate: n = 5 [69][70][71][72][73], 18F-FDG: n = 5 [74][75][76][77][78]). …”

PET Tracers Beyond FDG in Prostate Cancer

“…38 Patients underwent PET/CT with 11 C-acetate. Five underwent lymph node (LN) staging only and 102 LN staging and prostatectomy.…”