INTRODUCTION: Active surveillance (AS) is an increasingly popular management strategy for men diagnosed with low-risk indolent prostate cancer. Current tests (prostate-specific antigen [PSA], clinical staging, and prostate biopsies) to monitor indolent disease lack accuracy. (11)C-choline positron emission tomography (PET) has excellent detection rates in local and distant recurrence of prostate cancer. We examine (11)C-choline PET for identifying aggressive prostate cancer warranting treatment in the AS setting. METHODS: In total, 24 patients on AS had clinical assessment and PSA testing every 6 months and (11)C-choline PET and prostate biopsies annually. The sensitivity and specificity to identify prostate cancer and progressive disease (PD) were calculated for each (11)C-choline PET scan. RESULTS: In total, 62 biopsy-paired, serial (11)C-choline PET scans were analyzed using a series of standard uptake value-maximum (SUVmax) cut-off thresholds. During follow-up (mean 25.3 months), 11 of the 24 low-risk prostate cancer patients developed PD and received definitive treatment. The prostate cancer detection rate with (11)C-choline PET had moderate sensitivity (72.1%), but low specificity (45.0%). PD prediction from baseline (11)C-choline PET had satisfactory sensitivity (81.8%), but low specificity (38.5%). The addition of clinical parameters to the baseline (11)C-choline PET improved specificity (69.2%), with a slight reduction in sensitivity (72.7%) for PD prediction. CONCLUSIONS: Addition of (11)C-choline PET imaging during AS may help to identify aggressive disease earlier than traditional methods. However, (11)C-choline PET alone has low specificity due to overlap of SUV values with benign pathologies. Triaging low-risk prostate cancer patients into AS versus therapy will require further optimization of PET protocols or consideration of alternative strategies (i.e., magnetic resonance imaging, biomarkers).
INTRODUCTION: Active surveillance (AS) is an increasingly popular management strategy for men diagnosed with low-risk indolent prostate cancer. Current tests (prostate-specific antigen [PSA], clinical staging, and prostate biopsies) to monitor indolent disease lack accuracy. (11)C-choline positron emission tomography (PET) has excellent detection rates in local and distant recurrence of prostate cancer. We examine (11)C-choline PET for identifying aggressive prostate cancer warranting treatment in the AS setting. METHODS: In total, 24 patients on AS had clinical assessment and PSA testing every 6 months and (11)C-choline PET and prostate biopsies annually. The sensitivity and specificity to identify prostate cancer and progressive disease (PD) were calculated for each (11)C-choline PET scan. RESULTS: In total, 62 biopsy-paired, serial (11)C-choline PET scans were analyzed using a series of standard uptake value-maximum (SUVmax) cut-off thresholds. During follow-up (mean 25.3 months), 11 of the 24 low-risk prostate cancerpatients developed PD and received definitive treatment. The prostate cancer detection rate with (11)C-choline PET had moderate sensitivity (72.1%), but low specificity (45.0%). PD prediction from baseline (11)C-choline PET had satisfactory sensitivity (81.8%), but low specificity (38.5%). The addition of clinical parameters to the baseline (11)C-choline PET improved specificity (69.2%), with a slight reduction in sensitivity (72.7%) for PD prediction. CONCLUSIONS: Addition of (11)C-choline PET imaging during AS may help to identify aggressive disease earlier than traditional methods. However, (11)C-choline PET alone has low specificity due to overlap of SUV values with benign pathologies. Triaging low-risk prostate cancerpatients into AS versus therapy will require further optimization of PET protocols or consideration of alternative strategies (i.e., magnetic resonance imaging, biomarkers).
Authors: Naeem Bhojani; Laurent Salomon; Umberto Capitanio; Nazareno Suardi; Shahrokh F Shariat; Claudio Jeldres; Laurent Zini; Daniel Pharand; François Péloquin; Philippe Arjane; Claude C Abbou; Alexandre De La Taille; Francesco Montorsi; Pierre I Karakiewicz Journal: Int J Radiat Oncol Biol Phys Date: 2008-11-10 Impact factor: 7.038
Authors: Bernhard Scher; Michael Seitz; Wolfram Albinger; Reinhold Tiling; Michael Scherr; Hans-Christoph Becker; Michael Souvatzogluou; Franz-Josef Gildehaus; Hans-Jürgen Wester; Stefan Dresel Journal: Eur J Nucl Med Mol Imaging Date: 2006-08-24 Impact factor: 9.236
Authors: Daniel W Lin; Lisa F Newcomb; Elissa C Brown; James D Brooks; Peter R Carroll; Ziding Feng; Martin E Gleave; Raymond S Lance; Martin G Sanda; Ian M Thompson; John T Wei; Peter S Nelson Journal: Clin Cancer Res Date: 2013-03-20 Impact factor: 12.531
Authors: Natalia Arteaga-Marrero; Cecilie Brekke Rygh; Jose F Mainou-Gomez; Tom C H Adamsen; Nataliya Lutay; Rolf K Reed; Dag R Olsen Journal: J Transl Med Date: 2015-12-18 Impact factor: 5.531