, Volume 23, Issue 6, pp 541-548
Date: 16 Jun 2009

18F-choline PET/CT imaging of RECIST measurable lesions in hormone refractory prostate cancer

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Abstract

Purpose

Apply measurability criteria based on the response evaluation criteria in solid tumors (RECIST) to lesions found on 18F-choline positron emission tomography (PET)/computerized tomography (CT) in patients with hormone refractory prostate cancer.

Methods

Whole-body PET followed by CT or in-line PET/CT using 3.3–4 MBq/kg of 18F-choline was performed prospectively on 30 patients with prostate cancer, castrate testosterone levels, and rising post-treatment prostate specific antigen (PSA) levels. Lesions demonstrating increased 18F-choline uptake were classified as measurable or non-measureable based on RECIST.

Results

Three patients were known previously to have RECIST measurable lesions, 10 patients had metastatic findings on radionuclide bone scan, and 17 patients had elevated serum PSA level as the only evidence of disease. Lesions demonstrating increased 18F-choline uptake were found in 28 (93%) patients. Thirty-eight PET/CT lesions from 14 patients were measurable by RECIST. Lymph node maximum standardized uptake value (SUVmax) correlated with lymph node diameter (Pearson r = 0.44, p < 0. 001). RECIST measurable lymph node SUVmax was significantly higher than that of non-measurable nodes (8.1 vs. 3.7, p < 0.0001). Detection of skeletal, prostatic, or RECIST-compatible lesions was more likely with a PSA level greater than 4.0 ng/ml (Fisher exact p = 0.0005).

Conclusion

Lesions detected with 18F-choline PET/CT are frequently measurable by RECIST at baseline. Therefore, it may be feasible to include comparisons to RECIST in evaluations of 18F-choline as a therapeutic response marker for hormone refractory prostate cancer.

The findings and conclusions expressed in this study do not necessarily represent the views of The Queen’s Medical Center.