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Significant increase in detection of prostate cancer recurrence following radical prostatectomy with an early imaging acquisition protocol with 18F-fluorocholine positron emission tomography/computed tomography

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Abstract

Purpose

To highlight a new imaging acquisition protocol during 18F-fluorocholine PET/CT in patients with biochemical recurrence after RP.

Methods

A total of 146 patients with PSA levels between 0.2 and 1 ng/ml with negative conventional imaging who did not receive salvage treatment were prospectively enrolled. Imaging acquisition protocol included an early dynamic phase (1–8 min), a conventional whole body (10–20 min), and a late phase (30–40 min). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured. Univariable and multivariable analyses were performed to identify independent predictors of positive PET/CT.

Results

The median trigger PSA was 0.6 ng/ml (IQR 0.43–0.76). Median PSA doubling time (PSA DT) was 7.91 months (IQR 4.42–11.3); median PSA velocity (PSAV) was 0.02 ng/ml per month (IQR 0.02–0.04). Overall, 18F-fluorocholine PET/CT was positive in 111 of 146 patients (76 %). Out of 111 positive examinations, 80 (72.1 %) were positive only in the early dynamic phase. Sensitivity, specificity, PPV, NPV, and accuracy were 78.9, 76.9, 97.2, 26.3, and 78.7 %, respectively. At multivariable logistic regression, trigger PSA ≥ 0.6 ng/ml [odds ratio (OR) 3.13; p = 0.001] and PSAV ≥ 0.04 ng/ml per month (OR 4.95; p = 0.004) were independent predictors of positive PET/CT. The low NPV remains the main limitation of PET/CT in this setting of patients.

Conclusions

The increased sensitivity, thanks to the early imaging acquisition protocol, makes 18F-fluorocholine PET/CT an attractive tool to detect prostate cancer recurrences in patients with a PSA level <1 ng/ml.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The manuscript was approved by the institutional review board, and all patients gave written informed consent to treatment.

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Authors and Affiliations

  1. Department of Urology, “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy

    Giuseppe Simone, Rocco Papalia, Mariaconsiglia Ferriero, Salvatore Guaglianone & Michele Gallucci

  2. Department of Urology, “San Giovanni Bosco” Hospital, Turin, Italy

    Giuseppe Simone

  3. Department of Obstetrics, Gynecology and Urology, ‘Sapienza’ University, Rome, Italy

    Giovanni Battista Di Pierro

  4. Department of Nuclear Medicine, “Regina Elena” National Cancer Institute, Rome, Italy

    Rosa Sciuto, Sandra Rea & Carlo Ludovico Maini

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  1. Giuseppe Simone
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  2. Giovanni Battista Di Pierro
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  4. Rosa Sciuto
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  8. Carlo Ludovico Maini
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  9. Michele Gallucci
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Correspondence to Giuseppe Simone.

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Simone, G., Di Pierro, G.B., Papalia, R. et al. Significant increase in detection of prostate cancer recurrence following radical prostatectomy with an early imaging acquisition protocol with 18F-fluorocholine positron emission tomography/computed tomography. World J Urol 33, 1511–1518 (2015). https://doi.org/10.1007/s00345-015-1481-z

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  • DOI: https://doi.org/10.1007/s00345-015-1481-z

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