The Sensitivity of [11C]Choline PET/CT to Localize Prostate Cancer Depends on the Tumor Configuration

Abstract

Purpose: To evaluate the dependency of the sensitivity of [11 C]choline positron emission tomography/ computed tomography (PET/CT) for detecting and localizing primary prostate cancer (PCa) on tumor configuration in the histologic specimen. Experimental Design: Forty-three patients with biopsy-proven PCa were included. They underwent radical prostatectomy within 31 days after [11 C]choline PET/CT. The transaxial image slices and the histologic specimens were analyzed by comparing the respective slices. Maximum standardized uptake values (SUV max ) were calculated in each segment and correlated with histopathology. The tumor configuration in the histologic specimen was grouped as: I, unifocal; II, multifocal; III, rind-like shaped; IV, size <5 mm. Data analysis included the investigation of detection of PCa by SUV max , the assessment of the influence of potential contributing factors on tumor prediction, and the evaluation of whether SUV could discriminate cancer tissue from benign prostate hyperplasia (BPH), prostatitis, HGPIN (high-grade prostate intraepithelial neoplasm), or normal prostate tissue. General estimation equation models were used for statistical analysis.Results: Tumor configuration in histology was classified as I in 21 patients, as II in 9, as III in 5, and as IV in 8. The prostate segment involved by cancer is identified in 79% of the patients. SUV max was located in the same side of the prostate in 95% of patients. Tumor configuration was the only factor significantly negatively influencing tumor prediction (P < 0.001). PCa-SUV max (median SUV max ¼ 4.9) was not significantly different from BPH-SUV (median SUV max ¼ 4.5) and prostatitis-SUV (median SUV max ¼ 3.9), P ¼ 0.102 and P ¼ 0.054, respectively.Conclusions: The detection and localization of PCa in the prostate with [ 11 C]choline PET/CT is impaired by tumor configuration. Additionally, in our patient population, PCa tissue could not be distinguished from benign pathologies in the prostate.

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

“…One of these new tracers is the choline, a substrate for the synthesis of phosphatidylcholine which is the major phospholipid in the cell membrane [19]. Choline has been the most used tracer to study PC with PET-CT [22]. A target of the PET-CT procedure is the possibility to show with good sensitivity the staging of the disease in the whole body in one step.…”

PSMA Ligands for PET Imaging of Prostate Cancer

“…They were most frequently used for restaging of PC and primary staging in selected cases (e.g., high-risk PC). Detection and localization of primary PC are limited by nonspecific uptake in benign intraprostatic pathologies (9). Recent metaanalyses reported a high specificity of 95% but a poor sensitivity of 49% in primary nodal staging (10).…”

Writing PET into existence

“…Choline has demonstrated low sensitivity for the detection of primary prostate lesions and tumour configuration has been shown to affect diagnostic accuracy. Additionally, specificity is limited because PCa cannot be distinguished from prostatic hyperplasia, prostatitis and high-grade intraepithelial neoplasia [11]. For these reasons, the use of CHO cannot be recommended as a procedure for PCa detection.…”

“…FACBC shows high uptake in PCa deposits and appears to be safe for use in humans [26]. Preliminary data have shown that it might be superior to 11 C-CHO in the detection of recurrent PCa, but to date the only available report is that of a study in a small series of patients in which the results did not reach statistical significance and two nonestablished diagnostic modalities were compared, with no histological confirmation of the uptake areas [27].…”