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11C-Choline PET/CT in patients with hormone-resistant prostate cancer showing biochemical relapse after radical prostatectomy

  • Francesco Ceci
  • Paolo CastellucciEmail author
  • Marcelo Mamede
  • Riccardo Schiavina
  • Domenico Rubello
  • Chiara Fuccio
  • Valentina Ambrosini
  • Stefano Boschi
  • Giuseppe Martorana
  • Stefano Fanti
Original Article

Abstract

Purpose

To determine the diagnostic efficacy of 11C-choline PET/CT in patients with prostate cancer (PC) after radical prostatectomy who presented with increasing PSA levels during follow-up in spite of being on hormone treatment (HT), and therefore showing HT resistance.

Methods

We evaluated a large series of 157 consecutive PC patients previously treated by radical prostatectomy who presented with biochemical recurrence with increasing PSA levels in spite of ongoing HT (HT-resistant patients). At the time of 11C-choline PET/CT, the mean value of trigger PSA level was 8.3 (range  0.2 – 60.6 ng/mL), the mean PSA doubling time (PSAdt) was 5.3  (range  0.4 – 35 months), and the mean PSA velocity (PSAvel) was 22.1 ng/mL/year (range 0.12 – 82 ng/mL/year). 11C-Choline PET/CT was performed following a standard procedure at our centre to investigate increasing PSA levels, either as the first imaging procedure or in patients with negative conventional imaging. At the time of 11C-choline PET/CT all patients were receiving HT (61 were receiving monotherapy and 96 multidrug therapy). PET-positive findings were validated by: (a) transrectal US-guided biopsy in patients with recurrence in the prostatic bed, (b) surgical pelvic lymphadenectomy, (c) other imaging modalities, including repeated 11C-choline PET/CT, performed during a minimum follow-up of 12-months.

Results

11C-Choline PET/CT showed positive findings in 104 of the 157 patients (66 %). 11C-choline PET/CT detected: a single lesion in 40 patients (7 in the prostate bed, 10 in lymph nodes, 22 in bone, 1 at another site); two lesions in 18 patients (7 in lymph nodes, 7 in bone, 4 in both lymph nodes and bone); three or four lesions in 7 patients (4 in lymph nodes, 2 in bone, 1 at another site); and more than four lesions in the remaining 39 patients (2 in the prostate bed, 12 in lymph nodes, 12 in bone, 11 in both lymph nodes and bone, 2 at other sites). In 11C-choline PET-negative patients, the mean values of trigger PSA, PSAdt and PSAvel were 3.8 ng/mL (range 0.2 – 11.9 ng/mL) 7.0 months (range 1.21 – 35 months) and 5.8 ng/mL/year (range 0.12 – 30.1) respectively, while in 11C-Choline-PET-positive patients they were 10.5 ng/mL (range 0.2 – 60.6), 4.4 months (range 0.4 – 19.7) and 15.9 ng/mL/year (range 0.5 – 82.0) respectively. The differences between PET-negative and PET-positive patients were statistically significant for all these parameters: trigger PSA, p < 0.01; PSAdt, p < 0.01; PSAvel, p = 0.03.

Conclusion

In our patient population, 11C-choline PET/CT was able to detect relapsed disease in a large proportion of HT-resistant PC patients during HT. These data, obtained in a large series, suggest that HT withdrawal before performing a 11C-choline PET/CT scan may not be necessary for the detection of recurrent disease if PSA levels are increasing and PSA kinetics are rapid.

Keywords

Prostate cancer Radical prostatectomy Hormone therapy resistance 11C-Choline PET/CT Biochemical relapse, triggers PSA PSA kinetics 

Notes

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Francesco Ceci
    • 1
  • Paolo Castellucci
    • 1
    • 6
    Email author
  • Marcelo Mamede
    • 2
  • Riccardo Schiavina
    • 3
  • Domenico Rubello
    • 4
  • Chiara Fuccio
    • 5
  • Valentina Ambrosini
    • 1
  • Stefano Boschi
    • 1
  • Giuseppe Martorana
    • 3
  • Stefano Fanti
    • 1
  1. 1.Nuclear Medicine Unit, Department of Haematology Oncology and Laboratory Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant’Orsola-MalpighiUniversity of BolognaBolognaItaly
  2. 2.Molecular Imaging CenterUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  3. 3.Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant’Orsola-MalpighiUniversity of BolognaBolognaItaly
  4. 4.Department of Nuclear Medicine & PET/CT Centre‘Santa Maria della Misericordia’ HospitalRovigoItaly
  5. 5.Service of Nuclear MedicineFondazione Salvatore MaugeriPaviaItaly
  6. 6.UO di Medicina Nucleare, PAD. 30Azienda Ospedaliero-Unversitaria di Bologna Policlinico Sant’Orsola-MalpighiBolognaItaly

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