PURPOSE: The effectiveness of salvage therapy in prostate cancer is greater for low prostate specific antigen values.
Therefore, early detection of tumor recurrence is warranted. [11C]choline positron emission tomography/computerized tomography has the potential of early restaging of prostate cancer with low prostate specific antigen, but the selection of patients at high risk for positive [11C]choline positron emission tomography/computerized tomography is desirable to optimize salvage therapy.
MATERIALS AND METHODS: This retrospective study included 75 patients with prostate cancer with an increasing prostate specific antigen less than 1.5 ng/ml after radical prostatectomy who never received antiandrogen deprivation therapy or salvage radiotherapy who underwent [11C]choline positron emission tomography/computerized tomography for the restaging of disease. Binary logistic regression was used to assess predictive factors of positive [11C]choline positron emission tomography/computerized tomography. Included variables were trigger prostate specific antigen, prostate specific antigen doubling time, age, pathological stage and Gleason score.
RESULTS: Median prostate specific antigen was 0.61 ng/ml. [11C]choline positron emission tomography/computerized tomography was positive in 16 of 75 patients (21%). On univariate analysis prostate specific antigen doubling time less than 6 months was the only factor significantly associated with an increased risk of positive [11C]choline positron emission tomography/computerized tomography (OR 7.77, 95% CI 2.34-25.80, p = 0.001). In patients with prostate specific antigen doubling time less than 6 months, the positive detection rate of [11C]choline positron emission tomography/computerized tomography increased to 50%.
CONCLUSIONS: In patients with prostate cancer with biochemical failure after radical prostatectomy and prostate specific antigen less than 1.5 ng/ml, prostate specific antigen doubling time less than 6 months predicts positive [11C]choline positron emission tomography/computerized tomography. In these patients [11C]choline positron emission tomography/computerized tomography may reduce by 50% the number in whom salvage therapy is initiated empirically without knowing the disease location.
Written by:
Giovacchini G, Picchio M, Garcia-Parra R, Mapelli P, Briganti A, Montorsi F, Gianolli L, Messa C. Are you the author?
Tecnomed Foundation, University of Milano-Bicocca, San Raffaele Scientific Institute, Milano, Italy; Department of Radiooncology and Nuclear Medicine, Stadtspital Triemli, Zurich, Switzerland; Department of Radiology and Nuclear Medicine, Stadtspital Waid, Zurich, Switzerland.
Reference: J Urol. 2012 Nov 16. pii: S0022-5347(12)04813-6.
doi: 10.1016/j.juro.2012.09.001
PubMed Abstract
PMID: 23164385
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