Despite early detection programs, many patients with prostate cancer present with intermediate- or high-risk disease.
We prospectively investigated whether 11C-acetate PET/CT predicts lymph node (LN) metastasis and treatment failure in men for whom radical prostatectomy is planned.
METHODS: 107 men with intermediate- or high-risk localized prostate cancer and negative conventional imaging findings underwent PET/CT with 11C-acetate. Five underwent LN staging only, and 102 underwent LN staging and prostatectomy. PET/CT findings were correlated with pathologic nodal status. Treatment-failure-free survival was estimated by the Kaplan-Meier method. The ability of PET/CT to predict outcomes was evaluated by multivariate Cox proportional hazards analysis.
RESULTS: PET/CT was positive for pelvic LN or distant metastasis in 36 of 107 patients (33.6%). LN metastasis was present histopathologically in 25 (23.4%). The sensitivity, specificity, and positive and negative predictive values of PET/CT for detecting LN metastasis were 68.0%, 78.1%, 48.6%, and 88.9%, respectively. Treatment failed in 64 patients: 25 with metastasis, 17 with a persistent postprostatectomy prostate-specific antigen level greater than 0.20 ng/mL, and 22 with biochemical recurrence (prostate-specific antigen level > 0.20 ng/mL after nadir) during follow-up for a median of 44.0 mo. Treatment-failure-free survival was worse in PET-positive than in PET-negative patients (P < 0.0001) and in those with false-positive than in those with true-negative scan results (P < 0.01), suggesting that PET may have demonstrated nodal disease not removed surgically or identified pathologically. PET positivity independently predicted failure in preoperative (hazard ratio, 3.26; P < 0.0001) and postoperative (hazard ratio, 3.07; P = 0.0001) multivariate models.
CONCLUSION: In patients planned for or completing prostatectomy, 11C-acetate PET/CT detects LN metastasis not identified by conventional imaging and independently predicts treatment-failure-free survival.
Written by:
Haseebuddin M, Dehdashti F, Siegel BA, Liu J, Roth EB, Nepple KG, Siegel CL, Fischer KC, Kibel AS, Andriole GL, Miller TR. Are you the author?
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Reference: J Nucl Med. 2013 Mar 7. Epub ahead of print.
doi: 10.2967/jnumed.112.111153
PubMed Abstract
PMID: 23471311
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