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Prognostic value of metabolic parameters and clinical impact of 18F-fluorocholine PET/CT in biochemical recurrent prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging volume 42, pages 1784–1793 (2015)Cite this article

Abstract

Purpose

To evaluate the therapeutic impact of 18F-fluorocholine (FCH) PET/CT in biochemical recurrent prostate cancer (PC) and to investigate the value of quantitative FCH PET/CT parameters in predicting progression-free survival (PFS).

Methods

This retrospective study included 172 consecutive patients with PC who underwent FCH PET/CT for biochemical recurrence. Mean rising PSA was 10.7 ± 35.0 ng/ml. Patients with positive FCH PET were classified into three groups: those with uptake only in the prostatic bed, those with locoregional disease, and those with distant metastases. Referring physicians were asked to indicate the hypothetical therapeutic strategy with and without the FCH PET/CT results. Clinical variables and PET parameters including SUVmax, SUVpeak, SUVmean, total lesion choline kinase activity (TLCKA) and standardized added metabolic activity (SAM) were recorded and a multivariate analysis was performed to determine the factors independently predicting PFS.

Results

In 137 of the 172 patients, the FCH PET/CT scan was positive, and of these, 29.9 % (41/137) had prostatic recurrence, 42.3 % (58/137) had pelvic lymph node recurrence with or without prostatic recurrence, and 27.7 % (38/137) had distant metastases. The FCH PET/CT result led to a change in treatment plan in 43.6 % (75/172) of the 172 patients. Treatment was changed in 49.6 % (68/137) of those with a positive FCH PET/CT scan and in 20 % (7/35) of those with a negative FCH PET/CT scan. After a median follow-up of 29.3 months (95 % CI 18.9 – 45.9 months), according to multivariate analysis age <70 years, SAM ≥23 and SUVmean ≥3 were parameters independently predicting PFS. A nomogram constructed using the three parameters showed 49 months of PFS in patients with the best scores (0 or 1) and only 11 months in patients with a poor score (score 3).

Conclusion

This study indicates that a positive FCH PET result in PC patients with biochemical recurrence predicts a shorter PFS and confirms the major impact of the FCH PET result on the management of biochemical recurrent PC.

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Compliance with ethical standards

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Funding

This work was supported by grants from the French National Agency for Research called “Investissements d’Avenir”, Labex IRON no. ANR-11-LABX-0018-01 and Equipex ArronaxPlus no. ANR-11-EQPX-0004.

Conflicts of interest

None.

Informed consent

For this retrospective study, we obtained informed consent from all patients to allow the use of their clinical data for research purposes under a protocol approved in our institution.

Author information

Affiliations

  1. Nuclear Medicine, Institut de Cancérologie de l’Ouest René Gauducheau, Boulevard Jacques Monod, 44805 Nantes-St Herblain Cedex, France

    M. Colombié, C. Bailly, D. Rusu, N. Rousseau, F. Kraeber-Bodéré & C. Rousseau

  2. Statistics, ICO Cancer Center, Saint-Herblain, France

    L. Campion

  3. Urologic Clinic Nantes-Atlantis, Saint Herblain, France

    T. Rousseau

  4. Nuclear Medicine, University Hospital, Nantes, France

    C. Mathieu & F. Kraeber-Bodéré

  5. Physics, ICO Cancer Center, Saint-Herblain, France

    L. Ferrer

  6. Nantes-Angers Cancer Research Center, INSERM U892-CNRS UMR 6299, Nantes University, Nantes, France

    L. Campion, F. Kraeber-Bodéré & C. Rousseau

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  1. M. Colombié
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  2. L. Campion
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  7. L. Ferrer
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  10. C. Rousseau
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Correspondence to M. Colombié.

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Colombié, M., Campion, L., Bailly, C. et al. Prognostic value of metabolic parameters and clinical impact of 18F-fluorocholine PET/CT in biochemical recurrent prostate cancer. Eur J Nucl Med Mol Imaging 42, 1784–1793 (2015). https://doi.org/10.1007/s00259-015-3123-5

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  • DOI: https://doi.org/10.1007/s00259-015-3123-5

Keywords

  • Prostate cancer
  • 18F-Choline
  • PET/CT
  • Biochemical recurrence
  • Metabolic parameters