Skip to main content
Log in

Impact of sodium 18F-fluoride PET/CT, 18F-fluorocholine PET/CT and whole-body diffusion-weighted MRI on the management of patients with prostate cancer suspicious for metastasis: a prospective multicentre study

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To compare the impact of 18F-sodium-fluoride (NaF) PET/CT, 18F-fluorocholine (FCH) PET/CT and diffusion-weighted whole-body MRI (DW-MRI) on the management of patients with prostate cancer (PCa) suspicious for distant metastasis.

Methods

Prostate cancer patients were prospectively included between December 2011 and August 2014 and benefited from these three whole-body imaging (WBI) modalities within 1 month in addition to the standard PCa workup. Management was prospectively decided by clinicians during two multidisciplinary meetings, before and after the whole-body imaging workup. Rates of induced changes of whole-body imaging modalities were compared by Cochran’s Q test.

Results

One-hundred-one patients (27 at staging, 59 at first biochemical recurrence (BCR) and 15 at first episode of rising serum level of prostate-specific antigen during androgen-deprivation therapy) were included. The overall rate of management changes was 52%: 29% as a consequence of WBI, higher for FCH-PET/CT than for NaF-PET/CT or DW-MRI (p < 0.0001) and highest (41%) for FCH-PET/CT at BCR. Actual management was adequate in all patients but two.

Conclusions

Whole-body imaging induced a change in management in approximately a third of PCa patients suspicious for metastasis. The impact rate was determined to be greatest at first BCR using FCH-PET/CT. NaF-PET/CT and DW-MRI seemed less useful in this context.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cancer, prostate—National Comprehensive Cancer Network guidelines for treatment of Cancer by site. https://www.nccn.org/professionals/physician_gls/default.aspx#site. Accessed 3 May 2018

  2. James ND, Spears MR, Clarke NW et al (2015) Survival with newly diagnosed metastatic prostate cancer in the “docetaxel era”: data from 917 patients in the control arm of the STAMPEDE trial (MRC PR08, CRUK/06/019). Eur Urol 67:1028–1038

    Article  PubMed  Google Scholar 

  3. von Eyben FE, Kairemo K (2016) Acquisition with 11C-choline and 18F-fluorocholine PET/CT for patients with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Ann Nucl Med 30:385–392

    Article  Google Scholar 

  4. Mottet N, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71:618–629

    PubMed  Google Scholar 

  5. Shen G, Deng H, Hu S, Jia Z (2014) Comparison of choline-PET/CT, MRI, SPECT, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a meta-analysis. Skelet Radiol 43:1503–1513

    Article  Google Scholar 

  6. Hillner BE, Siegel BA, Hanna L et al (2014) Impact of 18F-fluoride PET in patients with known prostate cancer: initial results from the National Oncologic PET Registry. J Nucl Med 55:574–581

    Article  CAS  PubMed  Google Scholar 

  7. Jambor I, Kuisma A, Ramadan S et al (2016) Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5 T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial. Acta Oncol 55:59–67

    Article  PubMed  Google Scholar 

  8. Tateishi U, Morita S, Taguri M et al (2010) A meta-analysis of (18)F-fluoride positron emission tomography for assessment of metastatic bone tumor. Ann Nucl Med 24:523–531

    Article  PubMed  Google Scholar 

  9. Mosavi F, Johansson S, Sandberg DT et al (2012) Whole-body diffusion-weighted MRI compared with 18F-NaF PET/CT for detection of bone metastases in patients with high-risk prostate carcinoma. Am J Roentgenol 199:1114–1120

    Article  Google Scholar 

  10. Barchetti F, Stagnitti A, Megna V et al (2016) Unenhanced whole-body MRI versus PET-CT for the detection of prostate cancer metastases after primary treatment. Eur Rev Med Pharmacol Sci 20:3770–3776

    CAS  PubMed  Google Scholar 

  11. Beheshti M, Vali R, Waldenberger P et al (2008) Detection of bone metastases in patients with prostate cancer by 18F fluorocholine and 18F fluoride PET-CT: a comparative study. Eur J Nucl Med Mol Imaging 35:1766–1774

    Article  PubMed  Google Scholar 

  12. Langsteger W, Balogova S, Huchet V et al (2011) Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: prospective comparison of diagnostic performance determined by masked reading. Q J Nucl Med Mol Imaging 55:448–457

    CAS  PubMed  Google Scholar 

  13. European Medicine Agency (2009) Guideline on clinical evaluation of diagnostic agents. In: Guidel. Clin. Eval. Diagn. Agents. https://www.ema.europa.eu/ema/. Accessed 14 May 2018

  14. D’Amico AV, Moul J, Carroll PR et al (2004) Prostate specific antigen doubling time as a surrogate end point for prostate cancer specific mortality following radical prostatectomy or radiation therapy. J Urol 172:S42–S46 (discussion S46–S47)

    Google Scholar 

  15. Zumsteg ZS, Spratt DE, Romesser PB et al (2015) The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy. Eur Urol 67:1009–1016

    Article  PubMed  Google Scholar 

  16. Trock BJ, Han M, Freedland SJ et al (2008) Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299:2760–2769

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Cornford P, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71:630–642

    Article  PubMed  Google Scholar 

  18. Hodolic M, Michaud L, Huchet V et al (2014) Consequence of the introduction of routine FCH PET/CT imaging for patients with prostate cancer: a dual centre survey. Radiol Oncol 48:20–28

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kjölhede H, Ahlgren G, Almquist H et al (2012) Combined 18F-fluorocholine and 18F-fluoride positron emission tomography/computed tomography imaging for staging of high-risk prostate cancer. BJU Int 110:1501–1506

    Article  PubMed  Google Scholar 

  20. Soyka JD, Muster MA, Schmid DT et al (2012) Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer. Eur J Nucl Med Mol Imaging 39:936–943

    Article  CAS  PubMed  Google Scholar 

  21. Gillebert Q, Huchet V, Rousseau C et al (2018) 18F-fluorocholine PET/CT in patients with occult biochemical recurrence of prostate cancer: detection rate, impact on management and adequacy of impact. A prospective multicentre study. PLoS One 13:e0191487

    Article  PubMed  Google Scholar 

  22. Ceci F, Herrmann K, Castellucci P et al (2014) Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial. Eur J Nucl Med Mol Imaging 41:2222–2231

    Article  PubMed  Google Scholar 

  23. Lecouvet FE, Simon M, Tombal B et al (2010) Whole-body MRI (WB-MRI) versus axial skeleton MRI (AS-MRI) to detect and measure bone metastases in prostate cancer (PCa). Eur Radiol 20:2973–2982

    Article  CAS  PubMed  Google Scholar 

  24. Evangelista L, Cuppari L, Zattoni F et al (2018) The future of choline pet in the era of PMSA. Q J Nucl Med Mol Imaging. https://doi.org/10.23736/S1824-4785.18.03062-5

    Article  PubMed  Google Scholar 

  25. Afshar-Oromieh A, Zechmann CM, Malcher A et al (2014) Comparison of PET imaging with a 68Ga-labelled PSMA ligand and 18F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 41:11–20

    Article  CAS  PubMed  Google Scholar 

  26. Morigi JJ, Stricker PD, van Leeuwen PJ et al (2015) Prospective comparison of 18F-fluoromethylcholine versus 68Ga-PSMA PET/CT in prostate cancer patients who have rising PSA after curative treatment and are being considered for targeted therapy. J Nucl Med 56:1185–1190

    Article  CAS  PubMed  Google Scholar 

  27. Gauthé M, Belissant O, Girard A et al (2017) TEP/TDM et récidive biologique d’adénocarcinome prostatique: apport du 68Ga-PSMA-11 lorsque la 18F-fluorocholine n’est pas contributive. Prog En Urol 27:474–481

    Article  Google Scholar 

  28. Gauthé M, Bélissant O, Zhang Yin J et al (2017) TEP/TDM au 68Ga-PSMA-11 quand la 18F-fluorocholine ne localise pas la récidive biologique du cancer de la prostate : à propos d’un cas et revue de la littérature. Médecine Nucl. https://doi.org/10.1016/j.mednuc.2017.02.064

    Article  Google Scholar 

Download references

Acknowledgements

The authors want to thank Mrs. Zakia Idir, AP-HP, and Prof. Eric Vicaut and his team of URC Lariboisière for monitoring this study. They pay tribute to Pr. Gilles Grateau, Pr. Pierre Conort, Dr. Ahmed Khalil, Dr. Christophe Egrot, Dr. Jean-Marc Simon, Dr. Mohamed Tligui, Dr. Philippe Sebe, Dr. Bertrand Guillonneau, Dr. Jérome Parra, Dr. Sabrina Benbouzid, APHP, and Dr. Stéphane Supiot, ICO, for referring their patients and acknowledge their confidence

Author information

Authors and Affiliations

Authors

Contributions

MG project development, data collection, data revision, data analysis and manuscript writing. CA data collection, data revision and manuscript editing. FL data revision and manuscript editing. CR data collection and manuscript editing. MT data collection and manuscript editing. OC project development, data collection and manuscript editing. J-NT protocol development, data collection, data analysis and manuscript editing. ID-Z project development and manuscript editing.

Corresponding author

Correspondence to Mathieu Gauthé.

Ethics declarations

Conflict of interest

The “FLUPROSTIC” study (IDRCB 2011-A01041-40) was selected and granted by the French Ministry of Health (STIC 2009 P090105), and sponsored by the Assistance Publique-Hôpitaux de Paris (AP-HP). The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This protocol was approved by institutional and local human investigations committees, and informed written consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gauthé, M., Aveline, C., Lecouvet, F. et al. Impact of sodium 18F-fluoride PET/CT, 18F-fluorocholine PET/CT and whole-body diffusion-weighted MRI on the management of patients with prostate cancer suspicious for metastasis: a prospective multicentre study. World J Urol 37, 1587–1595 (2019). https://doi.org/10.1007/s00345-018-2547-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-018-2547-5

Keywords

Navigation