Oligometastatic recurrent prostate cancer detects by fluorine-18-choline positron emission tomography/computed tomography in patients with prostate-specific antigen levels of up to 5 ng/ml

Laura Evangelista, Lea Cuppari, Andrea Guttilla, Mario Gardi, Andrea Agostini, Lorenzo Ruggera, Umberto Basso, Giorgio Saladini

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Abstract

Purpose The aim of this study was to assess the ability of fluorine-18-fluorocholine (18F-FCH) PET/computed tomography (CT) to detect oligometastatic disease (OMD) in patients with early recurrence of prostate cancer (PC) [prostate-specific antigen (PSA)≤5 ng/ml]. Patients and methods Between 2010 and 2016, 324 patients with PC and PSA levels of less than or equal to 5 ng/ml were recruited. The mean (SD) age of the patients was 71 (10) years. All patients were treated with a radical prostatectomy±lymphadenectomy. One-hundred and twenty-one patients were under hormonal therapy at the time of PET/CT, whereas 203 were not. The mean (SD) PSA at the time of PET/CT was 1.33 (1.19) ng/ml, the mean (SD) PSA doubling time (PSAdt) was 10 (12) months, and the mean (SD) PSA velocity (PSAvel) was 1.94 (3.31) ng/ml/year. The correlation between continuous and categorical data was assessed using Student's t-test or by analysis of variance and by the χ 2-test, respectively. Univariate and multivariate analysis was carried out for the identification of clinical variables able to predict the presence of OMD. Results One-hundred and ninety-three patients had a negative 18F-FCH PET/CT, whereas 131 (40.4%) had a positive scan. Of these latter patients, 35 had a significant 18F-FCH uptake in the prostatic fossae, 59 in the lymph nodes, and 37 in bone. PSA levels were significantly different between patients with a positive than those with a negative scan (P<0.001). 18F-FCH PET/CT was negative in the majority of patients with a PSA of less than or equal to 1 (63.2%) ng/ml. More than 60% of patients with a PSAdt of less than or equal to 6 months had a positive 18F-FCH PET/CT scan for OMD. PSAvel was higher in patients with a positive scan than those with a negative finding. At univariate analysis, PSA level, PSAdt, and PSAvel were predictors of a positive 18F-FCH PET/CT for OMD, whereas on multivariate analysis, only PSA level and PSAdt were independent predictors (both P<0.01). Furthermore, PSAdt was the only independent predictor of OMD at the lymph node level. Conclusion In patients with early recurrence of PC, 18F-FCH PET/CT is able to detect OMD in 40% of cases. This finding has an important impact on the detection of PC recurrent lesions that could be treated by local therapy to achieve long-term survival or cure.

Original languageEnglish
Pages (from-to)260-267
Number of pages8
JournalNuclear Medicine Communications
Volume39
Issue number3
DOIs
Publication statusPublished - Jan 1 2018

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Fluorine
Prostate-Specific Antigen
Choline
Prostatic Neoplasms
Tomography
Positron Emission Tomography Computed Tomography
Multivariate Analysis
Lymph Nodes
Recurrence
fluorocholine
Analysis of Variance

Keywords

  • choline
  • oligometastasis
  • positron emission tomography
  • prostate cancer
  • prostate-specific antigen

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{6d931e2c082644c9bf9eb88824f1b2ca,
title = "Oligometastatic recurrent prostate cancer detects by fluorine-18-choline positron emission tomography/computed tomography in patients with prostate-specific antigen levels of up to 5 ng/ml",
abstract = "Purpose The aim of this study was to assess the ability of fluorine-18-fluorocholine (18F-FCH) PET/computed tomography (CT) to detect oligometastatic disease (OMD) in patients with early recurrence of prostate cancer (PC) [prostate-specific antigen (PSA)≤5 ng/ml]. Patients and methods Between 2010 and 2016, 324 patients with PC and PSA levels of less than or equal to 5 ng/ml were recruited. The mean (SD) age of the patients was 71 (10) years. All patients were treated with a radical prostatectomy±lymphadenectomy. One-hundred and twenty-one patients were under hormonal therapy at the time of PET/CT, whereas 203 were not. The mean (SD) PSA at the time of PET/CT was 1.33 (1.19) ng/ml, the mean (SD) PSA doubling time (PSAdt) was 10 (12) months, and the mean (SD) PSA velocity (PSAvel) was 1.94 (3.31) ng/ml/year. The correlation between continuous and categorical data was assessed using Student's t-test or by analysis of variance and by the χ 2-test, respectively. Univariate and multivariate analysis was carried out for the identification of clinical variables able to predict the presence of OMD. Results One-hundred and ninety-three patients had a negative 18F-FCH PET/CT, whereas 131 (40.4{\%}) had a positive scan. Of these latter patients, 35 had a significant 18F-FCH uptake in the prostatic fossae, 59 in the lymph nodes, and 37 in bone. PSA levels were significantly different between patients with a positive than those with a negative scan (P<0.001). 18F-FCH PET/CT was negative in the majority of patients with a PSA of less than or equal to 1 (63.2{\%}) ng/ml. More than 60{\%} of patients with a PSAdt of less than or equal to 6 months had a positive 18F-FCH PET/CT scan for OMD. PSAvel was higher in patients with a positive scan than those with a negative finding. At univariate analysis, PSA level, PSAdt, and PSAvel were predictors of a positive 18F-FCH PET/CT for OMD, whereas on multivariate analysis, only PSA level and PSAdt were independent predictors (both P<0.01). Furthermore, PSAdt was the only independent predictor of OMD at the lymph node level. Conclusion In patients with early recurrence of PC, 18F-FCH PET/CT is able to detect OMD in 40{\%} of cases. This finding has an important impact on the detection of PC recurrent lesions that could be treated by local therapy to achieve long-term survival or cure.",
keywords = "choline, oligometastasis, positron emission tomography, prostate cancer, prostate-specific antigen",
author = "Laura Evangelista and Lea Cuppari and Andrea Guttilla and Mario Gardi and Andrea Agostini and Lorenzo Ruggera and Umberto Basso and Giorgio Saladini",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/MNM.0000000000000808",
language = "English",
volume = "39",
pages = "260--267",
journal = "Nuclear Medicine Communications",
issn = "0143-3636",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Oligometastatic recurrent prostate cancer detects by fluorine-18-choline positron emission tomography/computed tomography in patients with prostate-specific antigen levels of up to 5 ng/ml

AU - Evangelista, Laura

AU - Cuppari, Lea

AU - Guttilla, Andrea

AU - Gardi, Mario

AU - Agostini, Andrea

AU - Ruggera, Lorenzo

AU - Basso, Umberto

AU - Saladini, Giorgio

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose The aim of this study was to assess the ability of fluorine-18-fluorocholine (18F-FCH) PET/computed tomography (CT) to detect oligometastatic disease (OMD) in patients with early recurrence of prostate cancer (PC) [prostate-specific antigen (PSA)≤5 ng/ml]. Patients and methods Between 2010 and 2016, 324 patients with PC and PSA levels of less than or equal to 5 ng/ml were recruited. The mean (SD) age of the patients was 71 (10) years. All patients were treated with a radical prostatectomy±lymphadenectomy. One-hundred and twenty-one patients were under hormonal therapy at the time of PET/CT, whereas 203 were not. The mean (SD) PSA at the time of PET/CT was 1.33 (1.19) ng/ml, the mean (SD) PSA doubling time (PSAdt) was 10 (12) months, and the mean (SD) PSA velocity (PSAvel) was 1.94 (3.31) ng/ml/year. The correlation between continuous and categorical data was assessed using Student's t-test or by analysis of variance and by the χ 2-test, respectively. Univariate and multivariate analysis was carried out for the identification of clinical variables able to predict the presence of OMD. Results One-hundred and ninety-three patients had a negative 18F-FCH PET/CT, whereas 131 (40.4%) had a positive scan. Of these latter patients, 35 had a significant 18F-FCH uptake in the prostatic fossae, 59 in the lymph nodes, and 37 in bone. PSA levels were significantly different between patients with a positive than those with a negative scan (P<0.001). 18F-FCH PET/CT was negative in the majority of patients with a PSA of less than or equal to 1 (63.2%) ng/ml. More than 60% of patients with a PSAdt of less than or equal to 6 months had a positive 18F-FCH PET/CT scan for OMD. PSAvel was higher in patients with a positive scan than those with a negative finding. At univariate analysis, PSA level, PSAdt, and PSAvel were predictors of a positive 18F-FCH PET/CT for OMD, whereas on multivariate analysis, only PSA level and PSAdt were independent predictors (both P<0.01). Furthermore, PSAdt was the only independent predictor of OMD at the lymph node level. Conclusion In patients with early recurrence of PC, 18F-FCH PET/CT is able to detect OMD in 40% of cases. This finding has an important impact on the detection of PC recurrent lesions that could be treated by local therapy to achieve long-term survival or cure.

AB - Purpose The aim of this study was to assess the ability of fluorine-18-fluorocholine (18F-FCH) PET/computed tomography (CT) to detect oligometastatic disease (OMD) in patients with early recurrence of prostate cancer (PC) [prostate-specific antigen (PSA)≤5 ng/ml]. Patients and methods Between 2010 and 2016, 324 patients with PC and PSA levels of less than or equal to 5 ng/ml were recruited. The mean (SD) age of the patients was 71 (10) years. All patients were treated with a radical prostatectomy±lymphadenectomy. One-hundred and twenty-one patients were under hormonal therapy at the time of PET/CT, whereas 203 were not. The mean (SD) PSA at the time of PET/CT was 1.33 (1.19) ng/ml, the mean (SD) PSA doubling time (PSAdt) was 10 (12) months, and the mean (SD) PSA velocity (PSAvel) was 1.94 (3.31) ng/ml/year. The correlation between continuous and categorical data was assessed using Student's t-test or by analysis of variance and by the χ 2-test, respectively. Univariate and multivariate analysis was carried out for the identification of clinical variables able to predict the presence of OMD. Results One-hundred and ninety-three patients had a negative 18F-FCH PET/CT, whereas 131 (40.4%) had a positive scan. Of these latter patients, 35 had a significant 18F-FCH uptake in the prostatic fossae, 59 in the lymph nodes, and 37 in bone. PSA levels were significantly different between patients with a positive than those with a negative scan (P<0.001). 18F-FCH PET/CT was negative in the majority of patients with a PSA of less than or equal to 1 (63.2%) ng/ml. More than 60% of patients with a PSAdt of less than or equal to 6 months had a positive 18F-FCH PET/CT scan for OMD. PSAvel was higher in patients with a positive scan than those with a negative finding. At univariate analysis, PSA level, PSAdt, and PSAvel were predictors of a positive 18F-FCH PET/CT for OMD, whereas on multivariate analysis, only PSA level and PSAdt were independent predictors (both P<0.01). Furthermore, PSAdt was the only independent predictor of OMD at the lymph node level. Conclusion In patients with early recurrence of PC, 18F-FCH PET/CT is able to detect OMD in 40% of cases. This finding has an important impact on the detection of PC recurrent lesions that could be treated by local therapy to achieve long-term survival or cure.

KW - choline

KW - oligometastasis

KW - positron emission tomography

KW - prostate cancer

KW - prostate-specific antigen

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U2 - 10.1097/MNM.0000000000000808

DO - 10.1097/MNM.0000000000000808

M3 - Article

C2 - 29381584

AN - SCOPUS:85043515382

VL - 39

SP - 260

EP - 267

JO - Nuclear Medicine Communications

JF - Nuclear Medicine Communications

SN - 0143-3636

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ER -