Its application is important in considering patients for radical salvage prostatectomy (SRP) in patients failing radiation therapy (XRT) for localized CaP. 11C-PET/CT is normally considered for the detection of systemic CaP spread and there is limited experience with regard to the sensitivity of C-PET/CT to detect locally recurrent CaP following XRT. They sought to analyze the sensitivity of C-PET/CT to diagnose CaP and extra- and intraprostatic extension. A total of 45 patients with the suspicion of locally recurrent CaP underwent 12-core transrectal ultrasound-guided biopsy of the prostate, C-PET/CT, bone scan and radical salvage prostatectomy. Imaging studies were correlated with pathologic findings of the prostate biopsy and the radical prostatectomy specimens.
The mean preoperative serum PSA was 7.8ng/ml, and the mean biopsy Gleason score was 5.6. The prostate biopsy was positive in 37/45 (82.2%) patients whereas 8/45 (17.8%) had a negative biopsy despite positive PET/CT findings. PET/CT was positive with 1-3 intraprostatic cancer foci in 45/45 patients. Radical prostatectomy specimens identified locally recurrent CaP in 44/45 (97.8%). One patient turned out to have pT0pN0 disease despite increasing PSA. PET/CT identified 1, 2, and > 2 intraprostatic cancer foci of significant volume in 23 (51.1%), 13 (28.9%) and 9 (20%) patients, respectively. Sensitivity to detect intraprostatic, pathologically proven CaP foci is 95.6%, which is significantly superior to the biopsy results. There was a high correlation between the PET/CT results and the final histology of the radical prostatectomy specimens.
Presented by Axel Heidenreich, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.
View Full AUA 2011 Meeting Coverage
