Role of 18F-choline PET/CT in biochemically relapsed prostate cancer after radical prostatectomy: correlation with trigger PSA, PSA velocity, PSA doubling time, and metastatic distribution.

Abstract

PURPOSE:

The aim of this study was to evaluate the efficacy of ¹⁸F-choline PET/CT (18FCH-PET/CT) in restaging patients previously treated by radical prostatectomy for a prostate cancer, presenting with biochemical relapse during follow-up (FU).

PATIENTS AND METHODS:

Three hundred thirty-one patients referred to us from January 2009 to April 2011 to perform 18FCH PET/CT were evaluated: 233 of them (mean age 69.7 years) met the inclusion criteria of the study: (1) biochemical relapse after radical prostatectomy (trigger PSA>0.2 ng/mL) (n=224) and (2) high risk for relapse (elevated Gleason score≥8) in spite PSA<0.1 ng/mL during FU (n=9). Trigger PSA was available for all patients (mean 8 ng/mL) and in 44 of them also PSA kinetic (PSA velocity-PSAvel; PSA doubling time-PSAdt). Correlation between 18FCH PET/CT detection rate and trigger PSA, PSAvel, PSAdt, and tumoral spread distribution were evaluated by univariate and multivariate analysis. Subsequent minimum FU was 1 year (mean 26 months, range 12-40).

RESULTS:

Overall detection rate of 18FCH PET/CT was 54%, which significantly increased when the trigger PSA increases (P<0.001). PET-positive patients presented a "fast" PSA kinetic (mean PSAdt=6 months and mean PSAvel=9.3 ng/mL/yr), while PET-negative patients presented a "slow" PSA kinetic (mean PSAdt=15.4 months and mean PSAvel=0.9 ng/mL/yr). Disease relapse was local in 17% of cases, distant in 66%, and combined in 17%.

CONCLUSIONS:

Overall 18FCH PET/CT detection rate was 54% (ie, similar to that reported in literature with ¹¹C-choline), which increases with the increase in trigger PSA: this condition was particularly true in patients with accelerated PSA kinetic. In about 20% of patients, 18FCH PET/CT demonstrated local relapses early enough to offer locoregional radiation therapy.

• Authors: Maria Cristina Marzola, Sotirios Chondrogiannis, Alice Ferretti, Gaia Grassetto, Lucia Rampin, Arianna Massaro, Paolo Castellucci, Maria Picchio, Adil Al-Nahhas, Patrick M Colletti, Adriano Marcolongo, Domenico Rubello
• Journal: Clinical nuclear medicine (Clin Nucl Med) Vol. 38 Issue 1 Pg. e26-32 (Jan 2013) ISSN: 1536-0229 [Electronic] United States
• PMID: 23242060 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• fluoromethylcholine
• Prostate-Specific Antigen
• Choline

Topics

• Aged
• Aged, 80 and over
• Choline (analogs & derivatives)
• Humans
• Male
• Middle Aged
• Multimodal Imaging
• Multivariate Analysis
• Neoplasm Metastasis
• Positron-Emission Tomography
• Prostate-Specific Antigen (metabolism)
• Prostatectomy
• Prostatic Neoplasms (diagnostic imaging, pathology, surgery)
• Recurrence
• Tomography, X-Ray Computed