11C-Choline PET/CT for restaging prostate cancer. Results from 4,426 scans in a single-centre patient series

Purpose To evaluate 11 C-choline PET/CT as a diagnostic tool for restaging prostate cancer (PCa), in a large, homogeneous and clinically relevant population of patients with biochemical recurrence (BCR) of PCa after primary therapy. The secondary aim was to assess the best timing for performing 11 C...

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Published in:European journal of nuclear medicine and molecular imaging 2016-10, Vol.43 (11), p.1971-1979
Main Authors: Graziani, Tiziano, Ceci, Francesco, Castellucci, Paolo, Polverari, Giulia, Lima, Giacomo Maria, Lodi, Filippo, Morganti, Alessio Giuseppe, Ardizzoni, Andrea, Schiavina, Riccardo, Fanti, Stefano
Format: Article
Language:English
Subjects:
Cancer surgery
Cardiology
Choline
Computed tomography
Deprivation
Diagnostic software
Diagnostic systems
Feasibility studies
Imaging
Incidence
Lesions
Medical imaging
Medicine
Medicine & Public Health
Metastases
Metastasis
Nuclear Medicine
Oncology
Original Article
Orthopedics
Patients
Positron emission
Prostate cancer
Prostatectomy
Radiation therapy
Radiology
Salvage
Tomography
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Summary:Purpose To evaluate 11 C-choline PET/CT as a diagnostic tool for restaging prostate cancer (PCa), in a large, homogeneous and clinically relevant population of patients with biochemical recurrence (BCR) of PCa after primary therapy. The secondary aim was to assess the best timing for performing 11 C-choline PET/CT during BCR. Methods We retrospectively analysed 9,632 11 C-choline PET/CT scans performed in our institution for restaging PCa from January 2007 to June 2015. The inclusion criteria were: (1) proven PCa radically treated with radical prostatectomy (RP) or with primary external beam radiotherapy (EBRT); (2) PSA serum values available; (3) proven BCR (PSA >0.2 ng/mL after RP or PSA >2 ng/mL above the nadir after primary EBRT with rising PSA levels). Finally, 3,203 patients with recurrent PCa matching all the inclusion criteria were retrospectively enrolled and 4,426 scans were analysed. Results Overall, 52.8 % of the 11 C-choline PET/CT scans (2,337/4,426) and 54.8 % of the patients (1,755/3,203) were positive. In 29.4 % of the scans, at least one distant finding was observed. The mean and median PSA values were, respectively, 4.9 and 2.1 ng/mL at the time of the scan (range 0.2 – 50 ng/mL). In our series, 995 scans were performed in patients with PSA levels between 1 and 2 ng/mL. In this subpopulation the positivity rate in the 995 scans was 44.7 %, with an incidence of distant findings of 19.2 % and an incidence of oligometastatic disease (one to three lesions) of 37.7 %. The absolute PSA value at the time of the scan and ongoing androgen deprivation therapy were associated with an increased probability of a positive 11 C-choline PET/CT scan ( p  
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-016-3428-z