The ability of 18F-choline PET/CT to identify local recurrence of prostate cancer

Laura Evangelista, Marino Cimitan, Marina Hodolič, Tanja Baseric, Jure Fettich, Eugenio Borsatti

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Purpose: To determine when 18F-choline PET/CT can truly identify local recurrence of prostate cancer. Methods: 1031 patients from 3 European centers underwent 18F-choline PET/CT (FCH PET/CT) for recurrent disease; 131 subjects (12.7%) showed a positive FCH uptake in the prostatic gland or prostatic fossa. Median age was 72 years (range 48–87 years), and the median PSA level at the time of FCH PET/CT scan was 4.41 ng/mL (0.22–18.13 ng/mL). 45 patients (34.4%) had a Gleason score (GS) >7, and the residual subjects had a GS ≤7. The assessment of true or false-positive FCH PET/CT findings was made by magnetic resonance imaging (n = 34) and/or biopsy in 75/131 cases. A χ2 test and a Z Kolmogorov–Smirnov test were used to assess the correlation between clinical variables (age, PSA, GS, type of therapy) and FCH PET/CT findings. Results: FCH PET/CT resulted truly positive (TP) for recurrent disease in the prostatic gland/fossa in 59/75 patients (79%) and falsely positive (FP) in 16 subjects (21%). The median value of PSA at the time of FCH PET/CT scan was higher in TP as compared to FP, although not statistically significant (4.76 vs. 3.04 ng/mL p > 0.05). Similarly, median age, GS categories, and the type of therapy were similar between the two groups (p > 0.05). However, when matching GS categories and PSA values, we found that the number of patients with TP findings were higher in the case of a PSA >2 ng/mL, independently from the GS (ranging between 74% and 92%). Conversely, FP rate ranged between 50% and 65% in patients with a PSA ≤2 ng/mL, especially in the case of GS ≤7, whereas FP was around 25% in those with a GS >7 and PSA >2 ng/mL. Conclusions: FCH PET/CT has a limited role in evaluation of prostatic gland/fossa recurrence, due to the physiological biodistribution of the radiopharmaceutical agent. However, in 70–90% of patients with a PSA >2 ng/mL, independently from GS, a focal FCH uptake is compatible with a true local recurrence.

Original languageEnglish
Pages (from-to)3230-3237
Number of pages8
JournalAbdominal Imaging
Volume40
Issue number8
DOIs
Publication statusPublished - Oct 1 2015

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Neoplasm Grading
Prostatic Neoplasms
Recurrence
Prostatic Diseases
fluoromethylcholine
Radiopharmaceuticals
Magnetic Resonance Imaging
Biopsy
Therapeutics

Keywords

  • 18F-choline PET/CT
  • False positive
  • Prostate cancer recurrence
  • Salvage treatments
  • True positive

ASJC Scopus subject areas

  • Gastroenterology
  • Urology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

The ability of 18F-choline PET/CT to identify local recurrence of prostate cancer. / Evangelista, Laura; Cimitan, Marino; Hodolič, Marina; Baseric, Tanja; Fettich, Jure; Borsatti, Eugenio.

In: Abdominal Imaging, Vol. 40, No. 8, 01.10.2015, p. 3230-3237.

Research output: Contribution to journalArticle

Evangelista, Laura ; Cimitan, Marino ; Hodolič, Marina ; Baseric, Tanja ; Fettich, Jure ; Borsatti, Eugenio. / The ability of 18F-choline PET/CT to identify local recurrence of prostate cancer. In: Abdominal Imaging. 2015 ; Vol. 40, No. 8. pp. 3230-3237.
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abstract = "Purpose: To determine when 18F-choline PET/CT can truly identify local recurrence of prostate cancer. Methods: 1031 patients from 3 European centers underwent 18F-choline PET/CT (FCH PET/CT) for recurrent disease; 131 subjects (12.7{\%}) showed a positive FCH uptake in the prostatic gland or prostatic fossa. Median age was 72 years (range 48–87 years), and the median PSA level at the time of FCH PET/CT scan was 4.41 ng/mL (0.22–18.13 ng/mL). 45 patients (34.4{\%}) had a Gleason score (GS) >7, and the residual subjects had a GS ≤7. The assessment of true or false-positive FCH PET/CT findings was made by magnetic resonance imaging (n = 34) and/or biopsy in 75/131 cases. A χ2 test and a Z Kolmogorov–Smirnov test were used to assess the correlation between clinical variables (age, PSA, GS, type of therapy) and FCH PET/CT findings. Results: FCH PET/CT resulted truly positive (TP) for recurrent disease in the prostatic gland/fossa in 59/75 patients (79{\%}) and falsely positive (FP) in 16 subjects (21{\%}). The median value of PSA at the time of FCH PET/CT scan was higher in TP as compared to FP, although not statistically significant (4.76 vs. 3.04 ng/mL p > 0.05). Similarly, median age, GS categories, and the type of therapy were similar between the two groups (p > 0.05). However, when matching GS categories and PSA values, we found that the number of patients with TP findings were higher in the case of a PSA >2 ng/mL, independently from the GS (ranging between 74{\%} and 92{\%}). Conversely, FP rate ranged between 50{\%} and 65{\%} in patients with a PSA ≤2 ng/mL, especially in the case of GS ≤7, whereas FP was around 25{\%} in those with a GS >7 and PSA >2 ng/mL. Conclusions: FCH PET/CT has a limited role in evaluation of prostatic gland/fossa recurrence, due to the physiological biodistribution of the radiopharmaceutical agent. However, in 70–90{\%} of patients with a PSA >2 ng/mL, independently from GS, a focal FCH uptake is compatible with a true local recurrence.",
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N2 - Purpose: To determine when 18F-choline PET/CT can truly identify local recurrence of prostate cancer. Methods: 1031 patients from 3 European centers underwent 18F-choline PET/CT (FCH PET/CT) for recurrent disease; 131 subjects (12.7%) showed a positive FCH uptake in the prostatic gland or prostatic fossa. Median age was 72 years (range 48–87 years), and the median PSA level at the time of FCH PET/CT scan was 4.41 ng/mL (0.22–18.13 ng/mL). 45 patients (34.4%) had a Gleason score (GS) >7, and the residual subjects had a GS ≤7. The assessment of true or false-positive FCH PET/CT findings was made by magnetic resonance imaging (n = 34) and/or biopsy in 75/131 cases. A χ2 test and a Z Kolmogorov–Smirnov test were used to assess the correlation between clinical variables (age, PSA, GS, type of therapy) and FCH PET/CT findings. Results: FCH PET/CT resulted truly positive (TP) for recurrent disease in the prostatic gland/fossa in 59/75 patients (79%) and falsely positive (FP) in 16 subjects (21%). The median value of PSA at the time of FCH PET/CT scan was higher in TP as compared to FP, although not statistically significant (4.76 vs. 3.04 ng/mL p > 0.05). Similarly, median age, GS categories, and the type of therapy were similar between the two groups (p > 0.05). However, when matching GS categories and PSA values, we found that the number of patients with TP findings were higher in the case of a PSA >2 ng/mL, independently from the GS (ranging between 74% and 92%). Conversely, FP rate ranged between 50% and 65% in patients with a PSA ≤2 ng/mL, especially in the case of GS ≤7, whereas FP was around 25% in those with a GS >7 and PSA >2 ng/mL. Conclusions: FCH PET/CT has a limited role in evaluation of prostatic gland/fossa recurrence, due to the physiological biodistribution of the radiopharmaceutical agent. However, in 70–90% of patients with a PSA >2 ng/mL, independently from GS, a focal FCH uptake is compatible with a true local recurrence.

AB - Purpose: To determine when 18F-choline PET/CT can truly identify local recurrence of prostate cancer. Methods: 1031 patients from 3 European centers underwent 18F-choline PET/CT (FCH PET/CT) for recurrent disease; 131 subjects (12.7%) showed a positive FCH uptake in the prostatic gland or prostatic fossa. Median age was 72 years (range 48–87 years), and the median PSA level at the time of FCH PET/CT scan was 4.41 ng/mL (0.22–18.13 ng/mL). 45 patients (34.4%) had a Gleason score (GS) >7, and the residual subjects had a GS ≤7. The assessment of true or false-positive FCH PET/CT findings was made by magnetic resonance imaging (n = 34) and/or biopsy in 75/131 cases. A χ2 test and a Z Kolmogorov–Smirnov test were used to assess the correlation between clinical variables (age, PSA, GS, type of therapy) and FCH PET/CT findings. Results: FCH PET/CT resulted truly positive (TP) for recurrent disease in the prostatic gland/fossa in 59/75 patients (79%) and falsely positive (FP) in 16 subjects (21%). The median value of PSA at the time of FCH PET/CT scan was higher in TP as compared to FP, although not statistically significant (4.76 vs. 3.04 ng/mL p > 0.05). Similarly, median age, GS categories, and the type of therapy were similar between the two groups (p > 0.05). However, when matching GS categories and PSA values, we found that the number of patients with TP findings were higher in the case of a PSA >2 ng/mL, independently from the GS (ranging between 74% and 92%). Conversely, FP rate ranged between 50% and 65% in patients with a PSA ≤2 ng/mL, especially in the case of GS ≤7, whereas FP was around 25% in those with a GS >7 and PSA >2 ng/mL. Conclusions: FCH PET/CT has a limited role in evaluation of prostatic gland/fossa recurrence, due to the physiological biodistribution of the radiopharmaceutical agent. However, in 70–90% of patients with a PSA >2 ng/mL, independently from GS, a focal FCH uptake is compatible with a true local recurrence.

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