Role of whole-body 18F-choline PET/CT in disease detection in patients with biochemical relapse after radical treatment for prostate cancer

Purpose

The aim of this study was to evaluate the role of whole body ¹⁸F-choline (FCH) positron emission tomography—computed tomography (PET-CT) in detecting and localising disease recurrence in patients presenting biochemical relapse after radical treatment for prostate cancer.

Materials and methods

Fifty-six consecutive patients with increased serum prostate-specific antigen (PSA) levels after radical prostatectomy were included in the study. None of them was receiving hormone treatment at the time of the examination or had been treated during the previous 6 months. All patients underwent whole-body ¹⁸F-choline PET imaging, and the pathological findings were compared with those of further imaging exams, biopsy and follow-up. On the basis of the PSA levels, we divided our patient population into three subgroups: PSA≤1, 15 ng/ml.

Results

Overall, the PET scan detected disease relapse in 42.9% of cases (24/56). PET sensitivity was closely related to serum PSA levels, showing values of 20%, 44% and 81.8% in the PSA≤1, 15ng/ml subgroups, respectively.

Conclusions

In patients with biochemical relapse after radical treatment for prostate cancer, ¹⁸F-choline PET-CT represents a single step, whole-body, noninvasive study that allows disease detection and localisation. The disease detection rate is related to serum PSA levels.     

Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer

Purpose

To investigate the clinical value of ¹⁸F-fluorocholine PET/CT (CH-PET/CT) in treatment decisions in patients with recurrent prostate cancer (rPCA).

Methods

The study was a retrospective evaluation of 156 patients with rPCA and CH-PET/CT for restaging. Questionnaires for each examination were sent to the referring physicians 14–64?months after examination. Questions included information regarding initial extent of disease, curative first-line treatment, and the treatment plan before and after CH-PET/CT. Additionally, PSA values at diagnosis, after initial treatment, before CH-PET/CT and at the end of follow-up were also obtained from the questionnaires.

Results

Mean follow-up was 42?months. The mean Gleason score was 6.9 at initial diagnosis. Initial treatment was: radical prostatectomy in 110 patients, radiotherapy in 39, and combined prostatectomy and radiotherapy in 7. Median PSA values before CH-PET/CT and at the end of follow-up were 3.40?ng/ml and 0.91?ng/ml. PSA levels remained stable, decreased or were below measurable levels in 108 patients. PSA levels increased in 48 patients. In 75 of the 156 patients (48%) the treatment plan was changed due to the CH-PET/CT findings. In 33 patients the therapeutic plan was changed from palliative treatment to treatment with curative intent. In 15 patients treatment was changed from curative to palliative. In 8 patients treatment was changed from curative to another strategy and in 2 patients from one palliative strategy to another. In 17 patients the treatment plan was adapted.

Conclusion

CH-PET/CT has an important impact on the therapeutic strategy in patients with rPCA and can help to determine an appropriate treatment.     

18F-choline PET/CT imaging of RECIST measurable lesions in hormone refractory prostate cancer

Purpose  Apply measurability criteria based on the response evaluation criteria in solid tumors (RECIST) to lesions found on ¹⁸F-choline positron emission tomography (PET)/computerized tomography (CT) in patients with hormone refractory prostate cancer. Methods  Whole-body PET followed by CT or in-line PET/CT using 3.3–4 MBq/kg of ¹⁸F-choline was performed prospectively on 30 patients with prostate cancer, castrate testosterone levels, and rising post-treatment prostate specific antigen (PSA) levels. Lesions demonstrating increased ¹⁸F-choline uptake were classified as measurable or non-measureable based on RECIST. Results  Three patients were known previously to have RECIST measurable lesions, 10 patients had metastatic findings on radionuclide bone scan, and 17 patients had elevated serum PSA level as the only evidence of disease. Lesions demonstrating increased ¹⁸F-choline uptake were found in 28 (93%) patients. Thirty-eight PET/CT lesions from 14 patients were measurable by RECIST. Lymph node maximum standardized uptake value (SUV_max) correlated with lymph node diameter (Pearson r = 0.44, p < 0. 001). RECIST measurable lymph node SUV_max was significantly higher than that of non-measurable nodes (8.1 vs. 3.7, p < 0.0001). Detection of skeletal, prostatic, or RECIST-compatible lesions was more likely with a PSA level greater than 4.0 ng/ml (Fisher exact p = 0.0005). Conclusion  Lesions detected with ¹⁸F-choline PET/CT are frequently measurable by RECIST at baseline. Therefore, it may be feasible to include comparisons to RECIST in evaluations of ¹⁸F-choline as a therapeutic response marker for hormone refractory prostate cancer. The findings and conclusions expressed in this study do not necessarily represent the views of The Queen’s Medical Center.     

18F-PSMA-1007 multiparametric,dynamic PET/CT in biochemical relapse and progression of prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging - Aim of the present analysis is to investigate the biodistribution and pharmacokinetics of the recently clinically introduced radioligand...     

18F-氟脱氧葡萄糖PET/CT在胰腺癌放疗中的应用

18F-氟脱氧葡萄糖PET/CT在胰腺癌的放疗中具有重要的应用价值。PET/CT较常规影像学检查能提高胰腺癌放疗前的诊断及分期准确性。在放疗过程中,以PET/CT检查为基础的靶区勾画能够准确地覆盖肿瘤组织及保护周围正常组织,同时可以按照其所提示的肿瘤代谢活性调整放疗计划。PET/CT还能够进行放疗的疗效评估及预后评判。相信随着研究的进展,18F-氟脱氧葡萄糖PET/CT将在胰腺癌放疗中发挥越来越重要的作用。     

18F-FDG PET/CT在前列腺癌中的应用进展

前列腺癌是临床常见的恶性肿瘤之一,在我国的发病率呈逐年上升趋势。18F-FDG是一种广谱的肿瘤非特异性显像剂,在多数肿瘤的临床应用中都具有重要价值。但临床实践表明,18F-FDG PET/CT显像在前列腺癌早期诊断中的价值是有限的。随着认识的深入,人们发现其在前列腺癌临床分期、疗效评价、预后评估等方面仍具有重要价值。笔者将对18F-FDG PET/CT在前列腺癌中的应用进展予以综述。     

Comparison of 18F-Choline PET/CT and MRI functional parameters in prostate cancer

Annals of Nuclear Medicine - 18F-Choline (FCH) uptake parameters are strong indicators of aggressive disease in prostate cancer. Functional parameters derived by magnetic resonance imaging (MRI)...     

Complementary roles of 18F-DOPA PET/CT and 18F-FDG PET/CT in medullary thyroid cancer

Serum calcitonin and carcinoembryonic antigen (CEA) are markers of recurrent or persistent disease in medullary thyroid cancer (MTC). However, conventional imaging often fails to localize metastatic disease. Our aim was to compare fluorine-labeled dihydroxyphenylalanine ((18)F-DOPA) and (18)F-FDG PET/CT with multidetector CT (MDCT) and MRI in recurrent or persistent MTC. METHODS: Nineteen MTC patients with increased calcitonin or CEA on follow-up (mean ± SD, 93 ± 91 mo; range, 4-300 mo) after primary therapy were prospectively imaged with 4 techniques: (18)F-DOPA PET/CT, (18)F-FDG PET/CT, MDCT, and MRI. Images were analyzed for pathologic lesions, which were surgically removed when possible. The correlation between the detection rate for each method and the calcitonin and CEA concentrations and histopathologic findings was investigated. Results: On the basis of histology and follow-up, one or more imaging methods accurately localized metastatic disease in 12 (63%) of 19 patients. The corresponding figures for (18)F-DOPA PET/CT, (18)F-FDG PET/CT, MDCT, and MRI were 11 (58%) of 19, 10 (53%) of 19, 9 (47%) of 19, and 10 (59%) of 17, respectively. Calcitonin and CEA correlated with (18)F-DOPA PET/CT (P = 0.0007 and P = 0.0263, respectively) and (18)F-FDG PET/CT findings (both P < 0.0001). In patients with an unstable calcitonin doubling time (n = 8), (18)F-DOPA and (18)F-FDG PET/CT were equally sensitive. In contrast, for patients with an unstable CEA doubling time (n = 4), (18)F-FDG PET/CT was more accurate. CONCLUSION: For most MTC patients with occult disease, (18)F-DOPA PET/CT accurately detects metastases. In patients with an unstable calcitonin level, (18)F-DOPA PET/CT and (18)F-FDG PET/CT are complementary. For patients with an unstable CEA doubling time, (18)F-FDG PET/CT may be more feasible. MRI is sensitive but has the highest rate of false-positive results.     

18F-FDG PET/CT在食管癌放疗中的应用

随着三维适形和调强放疗技术的发展,放射治疗成为食管癌的重要治疗手段之一。准确的肿瘤分期和精确的靶区勾画是食管癌精确放疗成功的先决条件。常规影像在指导食管癌精确放疗计划、早期疗效监测以及检测肿瘤复发中有很大帮助,但仍存在许多局限性。PET/CT作为一种功能与解剖的融合影像,可以弥补传统影像的某些不足,在食管癌的诊治中发挥着越来越重要的作用。该文将主要对18F-FDG PET/CT在食管癌放疗前分期、放疗靶区勾画、疗效监测及预后评估等方面的应用进行探讨。     

[18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients

Purpose We evaluated the potential of PET/CT and [¹⁸F]fluoromethylcholine (FCH) in the assessment of suspected recurrence of prostate cancer after treatment. Methods One hundred consecutive prostate cancer patients with a persistent increase in serum PSA (>0.1 ng/ml) after radical prostatectomy (58 cases), radiotherapy (21 cases) or hormonal therapy alone (21 cases) were investigated. After injection of 3.7–4.07 MBq/kg of FCH, both early (at <15 min) and delayed (at >60 min) PET/CT scans were performed in 43 patients, delayed PET/CT scans in 53 patients and early PET/CT scans in four patients. Results Of the 100 patients, 54 (PSA 0.22–511.79 ng/ml) showed positive FCH PET/CT scans. Thirty-seven patients had bone and/or abdominal lymph node uptake, while 17 showed pelvic activity. Malignant disease was confirmed in all but one. Delayed SUV_max of bone metastases was significantly higher (p<0.0001 by paired t test) than that measured at <15 min, whereas no differences were observed between early and delayed SUVs of malignant lymph nodes or pelvic disease. Forty-six patients (PSA 0.12–14.3 ng/ml) showed negative FCH PET/CT scans. Of the negative PET/CT scans, 89% were obtained in patients with serum PSA <4 ng/ml and 87% in patients with a Gleason score <8. In none of these cases could recurrent tumour be proven clinically during a follow-up of 6 months. Conclusion FCH PET/CT is not likely to have a significant impact on the care of prostate cancer patients with biochemical recurrence until PSA increases to above 4 ng/ml. However, in selected patients, FCH PET/CT helps to exclude distant metastases when salvage local treatment is intended.     

Imaging of proliferation with 18F-FLT PET/CT versus 18F-FDG PET/CT in non-small-cell lung cancer

Purpose  

To compare the diagnostic efficacies of ¹⁸F-FLT and ¹⁸F-FDG PET/CT in non-small-cell lung cancer (NSCLC), focusing on the correlation between FLT and FDG tumour uptake and tumour cell proliferation as indicated by the cyclin D1 labelling index.     

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

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.     

Prostate-specific antigen kinetics and choline PET/CT in patients with biochemical relapse after primary treatment for prostate cancer

Over the past few years, several studies have proved the potential role of diagnostic procedures in patients with treated prostate cancer who develop biochemical relapse. Notably, no precise indications exist regarding the use of emerging modalities such as positron emission tomography/computerized tomography (PET/CT) scanning with radiolabeled choline. However, the literature suggests that the main and most important application of choline PET/CT at present is in disease restaging in cases of biochemical relapse for the detection of local, lymph node-related or distant recurrence. In this setting, it is well known that prostate-specific antigen (PSA) values play a significant role in the follow-up of these patients. This short review aims at summarizing the results of the most relevant published studies with particular interest directed towards a better understanding of the relationship between PSA kinetics and choline PET/CT detection rate and the potential use of PSA kinetics for an optimal selection of patients who may benefit most from this diagnostic procedure particularly at an early stage of biochemical recurrence.     

Role of 11C-choline PET/CT in the re-staging of prostate cancer patients with biochemical relapse and negative results at bone scintigraphy

Aim

to evaluate the utility of ¹¹C-choline PET/CT in prostate cancer (PC) patients who have demonstrated a biochemical recurrence and a negative bone scintigraphy (BS).

Materials and methods

123 consecutive PC patients (mean age 67.6 years; range 54–83) with a biochemical relapse (mean PSA value 3.3 ng/mL; range 0.2–25.5) after radical prostatectomy (RP) were included in our retrospective study. Patients underwent a BS that resulted negative and a ¹¹C-choline PET/CT within 4 months from BS (range: 1 day to 4 months; mean: 2.5 months). Validation of results was established by: (1) a positive biopsy, (2) a positive subsequent BS, CT or MR and (3) a normalization of ¹¹C-choline uptake after systemic therapy or a progression of the disease.

Results

¹¹C-choline PET/CT was positive in 42/123 patients (34.1%). ¹¹C-choline PET/CT detected lesions in: bone (10 patients), lymph-nodes (20 patients), bone and lymph nodes (7 patients), bone and lung (1 patient), lymph-nodes and lung (1 patient), local relapse (3 patients). Overall, ¹¹C-choline PET/CT showed a total of 30 unknown bone lesions in 18/123 (14.6%) patients.

Conclusion

¹¹C-choline PET/CT showed a better sensitivity than BS in patients with biochemical relapse after RP: ¹¹C-choline PET/CT detected unknown bone lesions in 18/123 (14.6%) patients.     

18F-FDG PET/CT for staging of penile cancer.

The value of PET or PET/CT with (18)F-FDG for the staging of penile cancer has yet to be determined. The objective of this study was to investigate the pattern of (18)F-FDG uptake in the primary malignancy and its metastases and to determine the diagnostic value of (18)F-FDG PET/CT in the staging and restaging of penile cancer. METHODS: Thirteen patients (mean +/- SD age, 64 +/- 14.0 y) with suspected penile cancer or suspected recurrent disease were examined with a Gemini PET/CT system (200 MBq of (18)F-FDG). The reference standard was based on histopathologic findings obtained at biopsy or during surgery. RESULTS: Both the primary tumor and regional lymph node metastases exhibited a pattern of (18)F-FDG uptake typical for malignancy. Sensitivity in the detection of primary lesions was 75% (6/8), and specificity was 75% (3/4). On a per-patient basis, sensitivity in the detection of lymph node metastases was 80% (4/5), and specificity was 100% (8/8). On a nodal-group basis, PET/CT showed a sensitivity of 89% (8/9) in the detection of metastases in the superficial inguinal lymph node basins and a sensitivity of 100% (7/7) in the deep inguinal and obturator lymph node basins. The mean +/- SD maximum standardized uptake value for the 8 primary lesions was 5.3 +/- 3.7, and that for the 16 lymph node metastases was 4.6 +/- 2.0. CONCLUSION: According to our results, the main indication for (18)F-FDG PET in the primary staging or follow-up of penile cancer patients may be the prognostically crucial search for lymph node metastases. With the use of a PET/CT unit, the additional information provided by CT may be especially useful for planning surgery. Implementing (18)F-FDG PET and PET/CT in future staging algorithms may lead to a more precise and stage-appropriate therapeutic strategy. Furthermore, invasive procedures with a high morbidity rate, such as general bilateral lymphadenectomy, may be avoided.