PURPOSE: To determine the diagnostic efficacy of (11)C-choline PET/CT in patients with prostate cancer (PC) after radical prostatectomy who presented with increasing PSA levels during follow-up in spite of being on hormone treatment (HT), and therefore showing HT resistance. METHODS: We evaluated a large series of 157 consecutive PC patients previously treated by radical prostatectomy who presented with biochemical recurrence with increasing PSA levels in spite of ongoing HT (HT-resistant patients). At the time of (11)C-choline PET/CT, the mean value of trigger PSA level was 8.3 (range 0.2 - 60.6 ng/mL), the mean PSA doubling time (PSAdt) was 5.3 (range 0.4 - 35 months), and the mean PSA velocity (PSAvel) was 22.1 ng/mL/year (range 0.12 - 82 ng/mL/year). (11)C-Choline PET/CT was performed following a standard procedure at our centre to investigate increasing PSA levels, either as the first imaging procedure or in patients with negative conventional imaging. At the time of (11)C-choline PET/CT all patients were receiving HT (61 were receiving monotherapy and 96 multidrug therapy). PET-positive findings were validated by: (a) transrectal US-guided biopsy in patients with recurrence in the prostatic bed, (b) surgical pelvic lymphadenectomy, (c) other imaging modalities, including repeated (11)C-choline PET/CT, performed during a minimum follow-up of 12-months. RESULTS: (11)C-Choline PET/CT showed positive findings in 104 of the 157 patients (66 %). (11)C-choline PET/CT detected: a single lesion in 40 patients (7 in the prostate bed, 10 in lymph nodes, 22 in bone, 1 at another site); two lesions in 18 patients (7 in lymph nodes, 7 in bone, 4 in both lymph nodes and bone); three or four lesions in 7 patients (4 in lymph nodes, 2 in bone, 1 at another site); and more than four lesions in the remaining 39 patients (2 in the prostate bed, 12 in lymph nodes, 12 in bone, 11 in both lymph nodes and bone, 2 at other sites). In (11)C-choline PET-negative patients, the mean values of trigger PSA, PSAdt and PSAvel were 3.8 ng/mL (range 0.2-11.9 ng/mL) 7.0 months (range 1.21 - 35 months) and 5.8 ng/mL/year (range 0.12 - 30.1) respectively, while in (11)C-Choline-PET-positive patients they were 10.5 ng/mL (range 0.2 - 60.6), 4.4 months (range 0.4 - 19.7) and 15.9 ng/mL/year (range 0.5 - 82.0) respectively. The differences between PET-negative and PET-positive patients were statistically significant for all these parameters: trigger PSA, p < 0.01; PSAdt, p < 0.01; PSAvel, p = 0.03. CONCLUSION: In our patient population, (11)C-choline PET/CT was able to detect relapsed disease in a large proportion of HT-resistant PC patients during HT. These data, obtained in a large series, suggest that HT withdrawal before performing a (11)C-choline PET/CT scan may not be necessary for the detection of recurrent disease if PSA levels are increasing and PSA kinetics are rapid.
PURPOSE: To determine the diagnostic efficacy of (11)C-choline PET/CT in patients with prostate cancer (PC) after radical prostatectomy who presented with increasing PSA levels during follow-up in spite of being on hormone treatment (HT), and therefore showing HT resistance. METHODS: We evaluated a large series of 157 consecutive PC patients previously treated by radical prostatectomy who presented with biochemical recurrence with increasing PSA levels in spite of ongoing HT (HT-resistant patients). At the time of (11)C-choline PET/CT, the mean value of trigger PSA level was 8.3 (range 0.2 - 60.6 ng/mL), the mean PSA doubling time (PSAdt) was 5.3 (range 0.4 - 35 months), and the mean PSA velocity (PSAvel) was 22.1 ng/mL/year (range 0.12 - 82 ng/mL/year). (11)C-Choline PET/CT was performed following a standard procedure at our centre to investigate increasing PSA levels, either as the first imaging procedure or in patients with negative conventional imaging. At the time of (11)C-choline PET/CT all patients were receiving HT (61 were receiving monotherapy and 96 multidrug therapy). PET-positive findings were validated by: (a) transrectal US-guided biopsy in patients with recurrence in the prostatic bed, (b) surgical pelvic lymphadenectomy, (c) other imaging modalities, including repeated (11)C-choline PET/CT, performed during a minimum follow-up of 12-months. RESULTS: (11)C-Choline PET/CT showed positive findings in 104 of the 157 patients (66 %). (11)C-choline PET/CT detected: a single lesion in 40 patients (7 in the prostate bed, 10 in lymph nodes, 22 in bone, 1 at another site); two lesions in 18 patients (7 in lymph nodes, 7 in bone, 4 in both lymph nodes and bone); three or four lesions in 7 patients (4 in lymph nodes, 2 in bone, 1 at another site); and more than four lesions in the remaining 39 patients (2 in the prostate bed, 12 in lymph nodes, 12 in bone, 11 in both lymph nodes and bone, 2 at other sites). In (11)C-choline PET-negative patients, the mean values of trigger PSA, PSAdt and PSAvel were 3.8 ng/mL (range 0.2-11.9 ng/mL) 7.0 months (range 1.21 - 35 months) and 5.8 ng/mL/year (range 0.12 - 30.1) respectively, while in (11)C-Choline-PET-positive patients they were 10.5 ng/mL (range 0.2 - 60.6), 4.4 months (range 0.4 - 19.7) and 15.9 ng/mL/year (range 0.5 - 82.0) respectively. The differences between PET-negative and PET-positive patients were statistically significant for all these parameters: trigger PSA, p < 0.01; PSAdt, p < 0.01; PSAvel, p = 0.03. CONCLUSION: In our patient population, (11)C-choline PET/CT was able to detect relapsed disease in a large proportion of HT-resistant PC patients during HT. These data, obtained in a large series, suggest that HT withdrawal before performing a (11)C-choline PET/CT scan may not be necessary for the detection of recurrent disease if PSA levels are increasing and PSA kinetics are rapid.
Authors: Axel Heidenreich; Joaquim Bellmunt; Michel Bolla; Steven Joniau; Malcolm Mason; Vsevolod Matveev; Nicolas Mottet; Hans-Peter Schmid; Theo van der Kwast; Thomas Wiegel; Filliberto Zattoni Journal: Eur Urol Date: 2010-10-28 Impact factor: 20.096
Authors: T R DeGrado; R E Coleman; S Wang; S W Baldwin; M D Orr; C N Robertson; T J Polascik; D T Price Journal: Cancer Res Date: 2001-01-01 Impact factor: 12.701
Authors: B J Krause; M Souvatzoglou; M Tuncel; K Herrmann; A K Buck; C Praus; T Schuster; H Geinitz; U Treiber; M Schwaiger Journal: Eur J Nucl Med Mol Imaging Date: 2007-09-22 Impact factor: 9.236
Authors: Masood A Khan; H Ballentine Carter; Jonathan I Epstein; Michael C Miller; Patricia Landis; Patrick W Walsh; Alan W Partin; Robert W Veltri Journal: J Urol Date: 2003-12 Impact factor: 7.450
Authors: Onisuru T Okotie; William J Aronson; Jeff A Wieder; Yen Liao; Fred Dorey; Jean B DeKERNION; Stephen J Freedland Journal: J Urol Date: 2004-06 Impact factor: 7.450
Authors: Francesco Ceci; Christian Uprimny; Bernhard Nilica; Llanos Geraldo; Dorota Kendler; Alexander Kroiss; Jasmin Bektic; Wolfgang Horninger; Peter Lukas; Clemens Decristoforo; Paolo Castellucci; Stefano Fanti; Irene J Virgolini Journal: Eur J Nucl Med Mol Imaging Date: 2015-05-15 Impact factor: 9.236
Authors: Neeta Pandit-Taskar; Joseph A O'Donoghue; Volkan Beylergil; Serge Lyashchenko; Shutian Ruan; Stephen B Solomon; Jeremy C Durack; Jorge A Carrasquillo; Robert A Lefkowitz; Mithat Gonen; Jason S Lewis; Jason P Holland; Sarah M Cheal; Victor E Reuter; Joseph R Osborne; Massimo F Loda; Peter M Smith-Jones; Wolfgang A Weber; Neil H Bander; Howard I Scher; Michael J Morris; Steven M Larson Journal: Eur J Nucl Med Mol Imaging Date: 2014-08-21 Impact factor: 9.236
Authors: Francesco Ceci; Ken Herrmann; Paolo Castellucci; Tiziano Graziani; Christina Bluemel; Riccardo Schiavina; Christian Vollmer; Sabine Droll; Eugenio Brunocilla; Renzo Mazzarotto; Andreas K Buck; Stefano Fanti Journal: Eur J Nucl Med Mol Imaging Date: 2014-08-15 Impact factor: 9.236
Authors: Giampiero Giovacchini; Priscilla Guglielmo; Paola Mapelli; Elena Incerti; Ana Maria Samanes Gajate; Elisabetta Giovannini; Mattia Riondato; Alberto Briganti; Luigi Gianolli; Andrea Ciarmiello; Maria Picchio Journal: Eur J Nucl Med Mol Imaging Date: 2019-01-10 Impact factor: 9.236
Authors: Giampiero Giovacchini; Andrea Ciarmiello; Elisabetta Giovannini; Andrei Fodor; Cesare Cozzarini; Paola Mapelli; Elena Incerti; Nadia Di Muzio; Luigi Gianolli; Maria Picchio Journal: Eur J Nucl Med Mol Imaging Date: 2018-02-16 Impact factor: 9.236