Mathieu Gauthé1,2, Cyrielle Aveline3, Frédéric Lecouvet4, Laure Michaud3, Caroline Rousseau5,6, Marc Tassart7, Olivier Cussenot8,9, Jean-Noël Talbot3, Isabelle Durand-Zaleski10,11. 1. Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, 4 rue de la Chine, 75020, Paris, France. mathieugauthe@yahoo.fr. 2. AP-HP Health Economics Research Unit, INSERM UMR 1123, Paris, France. mathieugauthe@yahoo.fr. 3. Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, 4 rue de la Chine, 75020, Paris, France. 4. Department of Radiology, Centre du Cancer, Institut de Recherche Expérimentale Et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 5. Nuclear Medicine Unit, ICO Gauducheau Cancer Centre, Saint-Herblain, France. 6. Nantes-Angers Cancer Research Centre, INSERM U892, CNRS UMR 6299, Université de Nantes, Nantes, France. 7. Department of Radiology, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France. 8. Department of Urology, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France. 9. GRC No 5, ONCOTYPE-URO, Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France. 10. AP-HP Health Economics Research Unit, INSERM UMR 1123, Paris, France. 11. Service de Santé Publique, Hôpital Henri Mondor, AP-HP, Université Paris 12, Créteil, France.
Abstract
PURPOSE: To compare the impact of 18F-sodium-fluoride (NaF) PET/CT, 18F-fluorocholine (FCH) PET/CT and diffusion-weighted whole-body MRI (DW-MRI) on the management of patients with prostate cancer (PCa) suspicious for distant metastasis. METHODS: Prostate cancer patients were prospectively included between December 2011 and August 2014 and benefited from these three whole-body imaging (WBI) modalities within 1 month in addition to the standard PCa workup. Management was prospectively decided by clinicians during two multidisciplinary meetings, before and after the whole-body imaging workup. Rates of induced changes of whole-body imaging modalities were compared by Cochran's Q test. RESULTS: One-hundred-one patients (27 at staging, 59 at first biochemical recurrence (BCR) and 15 at first episode of rising serum level of prostate-specific antigen during androgen-deprivation therapy) were included. The overall rate of management changes was 52%: 29% as a consequence of WBI, higher for FCH-PET/CT than for NaF-PET/CT or DW-MRI (p < 0.0001) and highest (41%) for FCH-PET/CT at BCR. Actual management was adequate in all patients but two. CONCLUSIONS: Whole-body imaging induced a change in management in approximately a third of PCa patients suspicious for metastasis. The impact rate was determined to be greatest at first BCR using FCH-PET/CT. NaF-PET/CT and DW-MRI seemed less useful in this context.
PURPOSE: To compare the impact of 18F-sodium-fluoride (NaF) PET/CT, 18F-fluorocholine (FCH) PET/CT and diffusion-weighted whole-body MRI (DW-MRI) on the management of patients with prostate cancer (PCa) suspicious for distant metastasis. METHODS:Prostate cancerpatients were prospectively included between December 2011 and August 2014 and benefited from these three whole-body imaging (WBI) modalities within 1 month in addition to the standard PCa workup. Management was prospectively decided by clinicians during two multidisciplinary meetings, before and after the whole-body imaging workup. Rates of induced changes of whole-body imaging modalities were compared by Cochran's Q test. RESULTS: One-hundred-one patients (27 at staging, 59 at first biochemical recurrence (BCR) and 15 at first episode of rising serum level of prostate-specific antigen during androgen-deprivation therapy) were included. The overall rate of management changes was 52%: 29% as a consequence of WBI, higher for FCH-PET/CT than for NaF-PET/CT or DW-MRI (p < 0.0001) and highest (41%) for FCH-PET/CT at BCR. Actual management was adequate in all patients but two. CONCLUSIONS: Whole-body imaging induced a change in management in approximately a third of PCa patients suspicious for metastasis. The impact rate was determined to be greatest at first BCR using FCH-PET/CT. NaF-PET/CT and DW-MRI seemed less useful in this context.
Entities:
Keywords:
DW-MRI; Impact on management; PET/CT; Progression-free survival; Prostate cancer imaging
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