European Journal of Nuclear Medicine and Molecular Imaging

, Volume 37, Issue 2, pp 301–309

Predictive factors of [11C]choline PET/CT in patients with biochemical failure after radical prostatectomy

Authors

  • Giampiero Giovacchini
    • Center for Molecular BioimagingUniversity of Milano-Bicocca
  • Maria Picchio
    • Department of Nuclear MedicineScientific Institute San Raffaele
  • Elisa Coradeschi
    • Center for Molecular BioimagingUniversity of Milano-Bicocca
  • Valentino Bettinardi
    • Department of Nuclear MedicineScientific Institute San Raffaele
  • Luigi Gianolli
    • Department of Nuclear MedicineScientific Institute San Raffaele
  • Vincenzo Scattoni
    • Department of UrologyScientific Institute San Raffaele
  • Cesare Cozzarini
    • Department of Radiation OncologyScientific Institute San Raffaele
  • Nadia Di Muzio
    • Department of Radiation OncologyScientific Institute San Raffaele
  • Patrizio Rigatti
    • Department of UrologyScientific Institute San Raffaele
  • Ferruccio Fazio
    • Center for Molecular BioimagingUniversity of Milano-Bicocca
    • Department of Nuclear MedicineScientific Institute San Raffaele
    • Department of Radiation OncologyScientific Institute San Raffaele
    • Center for Molecular BioimagingUniversity of Milano-Bicocca
    • Institute for Bioimaging and Molecular PhysiologyNational Research Council
    • Department of Nuclear MedicineHospital San Gerardo
Original Article

DOI: 10.1007/s00259-009-1253-3

Cite this article as:
Giovacchini, G., Picchio, M., Coradeschi, E. et al. Eur J Nucl Med Mol Imaging (2010) 37: 301. doi:10.1007/s00259-009-1253-3

Abstract

Purpose

Detection of recurrence in prostate cancer patients with biochemical failure after radical prostatectomy by [11C]choline PET/CT depends on the prostate-specific antigen (PSA) level. The role of other clinical and pathological variables has not been explored.

Methods

A total of 2,124 prostate cancer patients referred to our Institution for [11C]choline PET/CT from December 2004 to January 2007 for restaging of disease were retrospectively considered for this study. Inclusion criteria were: previous treatment by radical prostatectomy, and biochemical failure, defined as at least two consecutive PSA measurements of >0.2 ng/ml. These criteria were met for 358 patients. Binary logistic analysis was used to investigate the predictive factors of [11C]choline PET/CT. PET/CT findings were validated using criteria based on histological analysis, and follow-up clinical and imaging data. Receiver operating characteristic (ROC) analysis was used to assess the performance of [11C]choline PET/CT in relation to PSA levels.

Results

The mean PSA level was 3.77 ± 6.94 ng/ml (range 0.23–45 ng/ml; median 1.27 ng/ml). PET/CT was positive for recurrence in 161 of 358 patients (45%). On an anatomical region basis, [11C]choline pathological uptake was observed in lymph nodes (107/161 patients, 66%), prostatectomy bed (55/161 patients, 34%), and in the skeleton (46/161 patients, 29%). PET/CT findings were validated using histological criteria (46/358, 13%), and follow-up clinical and imaging criteria (312/358, 87%). Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were, respectively, 85%, 93%, 91%, 87%, and 89%. In multivariate analysis, high PSA levels, advanced pathological stage, previous biochemical failure and older age were significantly (P < 0.05) associated with an increased risk of positive PET/CT findings. The percentage of positive scans was 19% in those with a PSA level between 0.2 and 1 ng/ml, 46% in those with a PSA level between 1 and 3 ng/ml, and 82% in those with a PSA level higher than 3 ng/ml. ROC analysis showed that PET/CT-positive and PET/CT-negative patients could be best distinguished using a PSA cut-off value of 1.4 ng/ml.

Conclusions

In addition to PSA levels, pathological stage, previous biochemical failure and age should be considered by physicians when referring prostate cancer patients with biochemical failure after radical prostatectomy to [11C]choline PET/CT.

Keywords

[11C]Choline PET/CTProstate cancerBiochemical failurePredictive factors

Copyright information

© Springer-Verlag 2009