Influence of PSA, PSA velocity and PSA doubling time on contrast-enhanced 18F-choline PET/CT detection rate in patients with rising PSA after radical prostatectomy

  • Orazio Schillaci
  • Ferdinando Calabria
  • Mario Tavolozza
  • Cristiana Ragano Caracciolo
  • Enrico Finazzi Agrò
  • Roberto Miano
  • Antonio Orlacchio
  • Roberta Danieli
  • Giovanni Simonetti
Original Article

DOI: 10.1007/s00259-011-2030-7

Cite this article as:
Schillaci, O., Calabria, F., Tavolozza, M. et al. Eur J Nucl Med Mol Imaging (2012) 39: 589. doi:10.1007/s00259-011-2030-7

Abstract

Purpose

To evaluate the accuracy of contrast-enhanced 18F-choline PET/CT in restaging patients with prostate cancer after radical prostatectomy in relation to PSA, PSA velocity (PSAve) and PSA doubling time (PSAdt).

Methods

PET/CT was performed in 49 patients (age range 58–87 years) with rising PSA (mean 4.13 ng/ml) who were divided in four groups according to PSA level: ≤1 ng/ml, 1 to ≤2 ng/ml, 2 to ≤4 ng/ml, and >4 ng/ml. PSAve and PSAdt were measured. PET and CT scans were interpreted separately and then together.

Results

PET/CT diagnosed relapse in 33 of the 49 patients (67%). The detection rates were 20%, 55%, 80% and 87% in the PSA groups ≤1, 1 to ≤2, 2 to ≤4 and >4 ng/ml, respectively. PET/CT was positive in 7 of 18 patients (38.9%) with a PSA ≤2 ng/ml, and in 26 of 31 (83.9%) with a PSA >2 ng/ml. PET/CT was positive in 7 of 25 patients (84%) with PSAdt ≤6 months, and in 12 of 24 patients (50%) with PSAdt >6 months, and was positive in 26 of 30 patients (86%) with a PSAve >2 ng/ml per year, and in 7 of 19 patients (36.8%) with PSAve ≤2 ng/ml per year. PET alone was positive in 31 of 49 patients (63.3%), and of these 31 patients, CT was negative in 14 but diagnosed bone lesions in 2 patients in whom PET alone was negative. CT with the administration of intravenous contrast medium did not provide any further information.

Conclusion

Detection rate of 18F-choline imaging is closely related to PSA and PSA kinetics. In particular, 18F-choline PET/CT is recommended in patients with PSA >2 ng/ml, PSAdt ≤6 months and PSAve >2 ng/ml per year. CT is useful for detecting bone metastases that are not 18F-choline-avid. The use of intravenous contrast agent seems unnecessary.

Keywords

18F-choline PET/CT Prostate cancer PSA kinetics Radical prostatectomy Contrast-enhanced CT 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Orazio Schillaci
    • 1
    • 2
  • Ferdinando Calabria
    • 2
  • Mario Tavolozza
    • 1
  • Cristiana Ragano Caracciolo
    • 1
  • Enrico Finazzi Agrò
    • 3
  • Roberto Miano
    • 3
  • Antonio Orlacchio
    • 1
  • Roberta Danieli
    • 1
  • Giovanni Simonetti
    • 1
  1. 1.Department of Biopathology and Diagnostic Imaging, InterventionalUniversity “Tor Vergata”RomeItaly
  2. 2.Department of Nuclear Medicine and Molecular ImagingIRCCS NeuromedPozzilliItaly
  3. 3.Department of UrologyUniversity Hospital “Tor Vergata”RomeItaly