INTRODUCTION: We examined the performance of 11C-choline PET/CT for its ability to delineate prostate cancer distribution and extent after initial therapy.
METHODS: A consecutive series retrospective review was performed of all prostate cancer patients who were evaluated using 11C-choline PET/CT from 9/2007 to 11/2010 at Mayo Clinic. Statistical analysis was performed to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and PSA threshold for detection of recurrent lesions.
RESULTS: Within the study period 176 patients with biochemical recurrence after primary treatment failure underwent 11C-choline PET/CT. Utilizing patient-based analysis 11C-choline PET yielded a sensitivity, specificity, PPV, and NPV of 93%, 76%, 91%, and 81%, respectively. 56 of 176 (32%) PET/CT scans performed were deemed clinically "useful" as defined by the ability to define lesions, not delineated using conventional imaging, thereby prompting changes in clinical management. The optimal PSA value for lesion detection was 2.0 ng/ml. On multivariate analysis, PSA at the time of PET scan (HR 1.37; p=0.04) and clinical stage at initial diagnosis of prostate cancer (HR 5.19; p=0.0035) were significant predictors of a positive 11C-choline PET/CT.
CONCLUSIONS: 11C-choline PET/CT performs well in men with biochemical recurrence following primary treatment failure. The optimal PSA value for lesion detection is around 2.0 ng/ml. We found that 11C-choline PET/CT substantially enhances the rate of prostate cancer lesion detection by approximately 32% beyond what can be garnered using conventional imaging techniques and at a lower PSA value.
Written by:
Mitchell CR, Lowe VJ, Rangel LJ, Hung JC, Kwon ED, Karnes RJ. Are you the author?
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Reference: J Urol. 2012 Oct 30. pii: S0022-5347(12)05357-8.
doi: 10.1016/j.juro.2012.10.069
PubMed Abstract
PMID: 23123372
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