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The ability of 18F-choline PET/CT to identify local recurrence of prostate cancer

Abdominal Imaging volume 40, pages 3230–3237 (2015)Cite this article

Abstract

Purpose

To determine when 18F-choline PET/CT can truly identify local recurrence of prostate cancer.

Methods

1031 patients from 3 European centers underwent 18F-choline PET/CT (FCH PET/CT) for recurrent disease; 131 subjects (12.7%) showed a positive FCH uptake in the prostatic gland or prostatic fossa. Median age was 72 years (range 48–87 years), and the median PSA level at the time of FCH PET/CT scan was 4.41 ng/mL (0.22–18.13 ng/mL). 45 patients (34.4%) had a Gleason score (GS) >7, and the residual subjects had a GS ≤7. The assessment of true or false-positive FCH PET/CT findings was made by magnetic resonance imaging (n = 34) and/or biopsy in 75/131 cases. A χ 2 test and a Z Kolmogorov–Smirnov test were used to assess the correlation between clinical variables (age, PSA, GS, type of therapy) and FCH PET/CT findings.

Results

FCH PET/CT resulted truly positive (TP) for recurrent disease in the prostatic gland/fossa in 59/75 patients (79%) and falsely positive (FP) in 16 subjects (21%). The median value of PSA at the time of FCH PET/CT scan was higher in TP as compared to FP, although not statistically significant (4.76 vs. 3.04 ng/mL p > 0.05). Similarly, median age, GS categories, and the type of therapy were similar between the two groups (p > 0.05). However, when matching GS categories and PSA values, we found that the number of patients with TP findings were higher in the case of a PSA >2 ng/mL, independently from the GS (ranging between 74% and 92%). Conversely, FP rate ranged between 50% and 65% in patients with a PSA ≤2 ng/mL, especially in the case of GS ≤7, whereas FP was around 25% in those with a GS >7 and PSA >2 ng/mL.

Conclusions

FCH PET/CT has a limited role in evaluation of prostatic gland/fossa recurrence, due to the physiological biodistribution of the radiopharmaceutical agent. However, in 70–90% of patients with a PSA >2 ng/mL, independently from GS, a focal FCH uptake is compatible with a true local recurrence.

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Acknowledgment

The author would like to thank Christina Drace for her help in the language revision for this manuscript.

Conflict of interest

None.

Author information

Affiliations

  1. Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV – IRCCS, Via Gattamelata, 64, 35128, Padua, Italy

    Laura Evangelista

  2. Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, PN, Italy

    Marino Cimitan, Tanja Baseric & Eugenio Borsatti

  3. Nuclear Medicine Research Department, IASON, Graz, Austria

    Marina Hodolič

  4. Nuclear Medicine Department, University Medical Center Ljubljana, Ljubljana, Slovenia

    Jure Fettich

Authors
  1. Laura Evangelista
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  2. Marino Cimitan
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  3. Marina Hodolič
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  4. Tanja Baseric
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  5. Jure Fettich
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  6. Eugenio Borsatti
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Correspondence to Laura Evangelista.

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Evangelista, L., Cimitan, M., Hodolič, M. et al. The ability of 18F-choline PET/CT to identify local recurrence of prostate cancer. Abdom Imaging 40, 3230–3237 (2015). https://doi.org/10.1007/s00261-015-0547-0

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  • DOI: https://doi.org/10.1007/s00261-015-0547-0

Keywords

  • Prostate cancer recurrence
  • 18F-choline PET/CT
  • False positive
  • True positive
  • Salvage treatments