alexa Utility of [11C]choline PET CT in guiding lesion-targeted salvage therapies in patients with prostate cancer recurrence localized to a single lymph node at imaging: results from a pathologically validated series.


Journal of Nuclear Medicine & Radiation Therapy

Author(s): Passoni NM, Suardi N, Abdollah F, Picchio M, Giovacchini G,

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Abstract OBJECTIVE: Positron emission tomography (PET)/computed tomography (CT) has been shown to be a valid tool in detecting lymph node (LN) metastases in men with biochemical recurrence after radical prostatectomy. We assessed its validity in detecting a single positive LN at pathologic examination in regard to an increasing interest in lesion-targeted salvage therapies. METHODS AND MATERIALS: We included 46 patients with biochemical recurrence after radical prostatectomy and a single positive spot at [(11)C]choline PET/CT who underwent pelvic or pelvic and retroperitoneal LN dissection. The ability of [(11)C]choline PET/CT in identifying the exact positive LN was assessed with the positive predictive value (PPV) in the overall population and according to androgen deprivation therapy, prostate-specific antigen value, and site of PET/CT positivity. RESULTS: Overall, 30 patients (65\%) had positive LNs at pathologic examination. Of these, only 16 (35\%) had pathologically confirmed metastases in the same lymphatic region and 11 (24\%) had involvement of 1 single LN. Conversely, 28 patients had positive LNs in other areas and 8 had no evidence of metastases. The overall PPV of PET/CT was 34.8\% and 23.9\% when exact concordance was defined according to the lymphatic landing site and single positive LN, respectively. The PPV ranged from 33.3\% to 44.4\% and from 17.9\% to 28.6\%, in men with and without androgen deprivation therapy, respectively. CONCLUSIONS: The PPV [(11)C]choline of PET/CT in correctly identifying patients with a single positive LN at salvage LN dissection is poor (24\%). Therefore, extensive salvage treatment approaches are needed to maximize the chance of cure. Copyright © 2014 Elsevier Inc. All rights reserved. This article was published in Urol Oncol and referenced in Journal of Nuclear Medicine & Radiation Therapy

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