alexa Role of 18F-choline PET CT in biochemically relapsed prostate cancer after radical prostatectomy: correlation with trigger PSA, PSA velocity, PSA doubling time, and metastatic distribution.


Journal of Nuclear Medicine & Radiation Therapy

Author(s): Marzola MC, Chondrogiannis S, Ferretti A, Grassetto G, Rampin L,

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Abstract PURPOSE: The aim of this study was to evaluate the efficacy of ¹⁸F-choline PET/CT (18FCH-PET/CT) in restaging patients previously treated by radical prostatectomy for a prostate cancer, presenting with biochemical relapse during follow-up (FU). PATIENTS AND METHODS: Three hundred thirty-one patients referred to us from January 2009 to April 2011 to perform 18FCH PET/CT were evaluated: 233 of them (mean age 69.7 years) met the inclusion criteria of the study: (1) biochemical relapse after radical prostatectomy (trigger PSA>0.2 ng/mL) (n=224) and (2) high risk for relapse (elevated Gleason score≥8) in spite PSA<0.1 ng/mL during FU (n=9). Trigger PSA was available for all patients (mean 8 ng/mL) and in 44 of them also PSA kinetic (PSA velocity-PSAvel; PSA doubling time-PSAdt). Correlation between 18FCH PET/CT detection rate and trigger PSA, PSAvel, PSAdt, and tumoral spread distribution were evaluated by univariate and multivariate analysis. Subsequent minimum FU was 1 year (mean 26 months, range 12-40). RESULTS: Overall detection rate of 18FCH PET/CT was 54\%, which significantly increased when the trigger PSA increases (P<0.001). PET-positive patients presented a "fast" PSA kinetic (mean PSAdt=6 months and mean PSAvel=9.3 ng/mL/yr), while PET-negative patients presented a "slow" PSA kinetic (mean PSAdt=15.4 months and mean PSAvel=0.9 ng/mL/yr). Disease relapse was local in 17\% of cases, distant in 66\%, and combined in 17\%. CONCLUSIONS: Overall 18FCH PET/CT detection rate was 54\% (ie, similar to that reported in literature with ¹¹C-choline), which increases with the increase in trigger PSA: this condition was particularly true in patients with accelerated PSA kinetic. In about 20\% of patients, 18FCH PET/CT demonstrated local relapses early enough to offer locoregional radiation therapy. This article was published in Clin Nucl Med and referenced in Journal of Nuclear Medicine & Radiation Therapy

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