Ur Metser1, Alejandro Berlin2, Jaydeep Halankar1, Grainne Murphy1, Kartik S Jhaveri1, Sangeet Ghai1, Noam Tau1. 1. 1 Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON M5G 2M9, Canada. 2. 2 Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Abstract
OBJECTIVE: The purpose of this study was to determine whether integrated 18F-fluorocholine (FCH) PET whole-body MRI (PET/WBMRI) depicts lymph node and distant metastases in patients with high-risk prostate cancer more frequently than does conventional staging. SUBJECTS AND METHODS: A prospective study included 58 patients with untreated high-risk prostate cancer. After conventional staging (CT and bone scintigraphy), patients underwent FCH PET/WBMRI (n = 10) or FCH PET/CT and WBMRI (n = 48). Metastatic sites and disease stage were recorded for each modality (conventional imaging, PET, WBMRI, and PET/WBMRI) and compared with a standard of reference (histopathologic examination, imaging, and clinical follow-up) and early clinical outcomes. RESULTS: In the detection of metastases, PET had significantly higher sensitivity (72/77 [93.5%]) than conventional imaging (49/77 [63.6%]; p < 0.001) and WBMRI (56/77 [72.7%]; p = 0.002). There was a trend toward improved detection with PET/WBMRI (77/77 [100%]) compared with PET alone (p = 0.059). For correct NM staging, PET and PET/WBMRI performed better than conventional imaging (p = 0.002) and WBMRI (p = 0.008). Twelve of 56 patients (21.4%) had early biochemical failure after radical treatment (median, 7 months; range, 1-20 months). This rate was higher for patients with M1a or M1b disease at PET/WBMRI than for others, but this finding did not reach statistical significance (4/8 [50%] vs 8/48 [16.7%]; p = 0.055). CONCLUSION: In patients with high-risk prostate cancer, FCH PET and FCH PET/WBMRI depict significantly more metastatic lesions than do conventional imaging and WBMRI. Stage determined with PET/WBMRI may correlate with early outcomes.
OBJECTIVE: The purpose of this study was to determine whether integrated 18F-fluorocholine (FCH) PET whole-body MRI (PET/WBMRI) depicts lymph node and distant metastases in patients with high-risk prostate cancer more frequently than does conventional staging. SUBJECTS AND METHODS: A prospective study included 58 patients with untreated high-risk prostate cancer. After conventional staging (CT and bone scintigraphy), patients underwent FCH PET/WBMRI (n = 10) or FCH PET/CT and WBMRI (n = 48). Metastatic sites and disease stage were recorded for each modality (conventional imaging, PET, WBMRI, and PET/WBMRI) and compared with a standard of reference (histopathologic examination, imaging, and clinical follow-up) and early clinical outcomes. RESULTS: In the detection of metastases, PET had significantly higher sensitivity (72/77 [93.5%]) than conventional imaging (49/77 [63.6%]; p < 0.001) and WBMRI (56/77 [72.7%]; p = 0.002). There was a trend toward improved detection with PET/WBMRI (77/77 [100%]) compared with PET alone (p = 0.059). For correct NM staging, PET and PET/WBMRI performed better than conventional imaging (p = 0.002) and WBMRI (p = 0.008). Twelve of 56 patients (21.4%) had early biochemical failure after radical treatment (median, 7 months; range, 1-20 months). This rate was higher for patients with M1a or M1b disease at PET/WBMRI than for others, but this finding did not reach statistical significance (4/8 [50%] vs 8/48 [16.7%]; p = 0.055). CONCLUSION: In patients with high-risk prostate cancer, FCH PET and FCH PET/WBMRI depict significantly more metastatic lesions than do conventional imaging and WBMRI. Stage determined with PET/WBMRI may correlate with early outcomes.