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[11C]Choline PET/CT predicts survival in hormone-naive prostate cancer patients with biochemical failure after radical prostatectomy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Over the last decade, PET/CT with radiolabelled choline has been shown to be useful for restaging patients with prostate cancer (PCa) who develop biochemical failure. The limitations of most clinical studies have been poor validation of [11C]choline PET/CT-positive findings and lack of survival analysis. The aim of this study was to assess whether [11C]choline PET/CT can predict survival in hormone-naive PCa patients with biochemical failure.

Methods

This retrospective study included 302 hormone-naive PCa patients treated with radical prostatectomy who underwent [11C]choline PET/CT from 1 December 2004 to 31 July 2007 because of biochemical failure (prostate-specific antigen, PSA, >0.2 ng/mL). Median PSA was 1.02 ng/mL. PCa-specific survival was estimated using Kaplan-Meier curves. Cox regression analysis was used to evaluate the association between clinicopathological variables and PCa-specific survival. The coefficients of the covariates included in the Cox regression analysis were used to develop a novel nomogram.

Results

Median follow-up was 7.2 years (1.4 – 18.9 years). [11C]Choline PET/CT was positive in 101 of 302 patients (33 %). Median PCa-specific survival after prostatectomy was 14.9 years (95 % CI 9.7 – 20.1 years) in patients with positive [11C]choline PET/CT. Median survival was not achieved in patients with negative [11C]choline PET/CT. The 15-year PCa-specific survival probability was 42.4 % (95 % CI 31.7 – 53.1 %) in patients with positive [11C]choline PET/CT and 95.5 % (95 % CI 93.5 – 97.5 %) in patients with negative [11C]choline PET/CT. In multivariate analysis, [11C]choline PET/CT (hazard ratio 6.36, 95 % CI 2.14 – 18.94, P < 0.001) and Gleason score >7 (hazard ratio 3.11, 95 % CI 1.11 – 8.66, P = 0.030) predicted PCa-specific survival. An internally validated nomogram predicted 15-year PCa-specific survival probability with an accuracy of 80 %.

Conclusion

Positive [11C]choline PET/CT after biochemical failure predicts PCa-specific survival in hormone-naive PCa patients. Prospective studies are warranted to confirm our results before more extensive use of [11C]choline PET/CT for prognostic stratification of PCa patients.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Correspondence to Maria Picchio.

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Giovacchini, G., Incerti, E., Mapelli, P. et al. [11C]Choline PET/CT predicts survival in hormone-naive prostate cancer patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging 42, 877–884 (2015). https://doi.org/10.1007/s00259-015-3015-8

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  • DOI: https://doi.org/10.1007/s00259-015-3015-8

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