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. 2017 Jan-Feb;11(1-2):47-52.
doi: 10.5489/cuaj.4068.

Initial single-centre Canadian experience with 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/CT) for biochemical recurrence in prostate cancer patients initially treated with curative intent

Simon Gauvin  1 , Yannick Cerantola  2   3 , Eléonore Haberer  1   2 , Vincent Pelsser  1 , Stephan Probst  4 , Franck Bladou  2 , Maurice Anidjar  2
Affiliations

Initial single-centre Canadian experience with 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/CT) for biochemical recurrence in prostate cancer patients initially treated with curative intent

Simon Gauvin et al. Can Urol Assoc J. 2017 Jan-Feb.

Abstract

Introduction: We sought to determine predictive factors (patient and prostate-specific antigen [PSA] characteristics) for 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/CT) positivity in the context of biochemical recurrence after local treatment of prostate cancer (PCa) with curative intent.

Methods: This is a retrospective study including 60 18F-FCH PET/CT scans of patients with biochemical recurrence after initial radical prostatectomy (RP), external beam radiation therapy (EBRT), or focal high-intensity focused ultrasound (HIFU) with curative intent. The results were compared to findings on magnetic resonance imaging (MRI), computed tomography (CT), bone scan (BS), and histological analysis when available. Univariate analysis was performed to correlate results with patient characteristics.

Results: Thirty-eight (63.3%) scans were positive, 17 (28.3%) negative, and 5 (8.3%) equivocal. Of the positive scans, 16 demonstrated local recurrence, 12 regional/distant lymph nodes, five bone metastasis, and five local and distant recurrences. Among the 22 PET/CTs showing metastasis, conventional imaging was performed in 16 patients (72.7%). Of these, it demonstrated the lesion(s) found on PET/CT in eight patients (50.0%), was negative in seven (43.8%), and equivocal in one (6.3%). The trigger PSA (p=0.04), prostate-specific antigen velocity (PSAV) (p=0.03), and prostate-specific antigen doubling time (PSADT) (p=0.046) were significantly different when comparing positive and negative scans. Patients with positive scans were more likely to have received EBRT initially (odds ratio [OR] 11.0, 95% confidence interval [CI] 2.2-55.3). A trigger PSA of 2.6 ng/mL had a sensitivity of 84% and specificity of 65% for a positive scan. PET/CT changed the clinical management plan in 17 patients (28.3%).

Conclusions: 18F-FCH PET/CT demonstrates a high detection rate for local and distant recurrences after localized PCa treatment. A trigger PSA above 2.6 ng/mL seems optimal for appropriate patient selection.

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Figures

Fig. 1.
Fig. 1.
Examples of positive 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/CT) scans. (A) Axial 18F-FCH PET/CT images obtained from a patient with biochemical recurrence initially treated with external beam radiation therapy (EBRT). Focal uptake in the left prostate is demonstrated (SUV 7.2). The patient subsequently underwent salvage brachytherapy with response in prostate-specific antigen; (B) axial PET/CT images from a different patient with biochemical recurrence after initial radical prostatectomy demonstrating an enlarged right common iliac lymph node with high uptake (SUV 12.2), consistent with recurrence. Followup imaging later showed complete resolution of lymphadenopathy after the patient received hormonotherapy; (C) axial PET/CT images from another patient with initial EBRT demonstrating increased uptake in the left posterior iliac bone (SUV 8.3), consistent with a bone metastasis.
Fig. 2.
Fig. 2.
Trigger prostate-specific antigen (PSA) and PSA velocity (PSAV) receiver operating characteristic (ROC) curves.
See this image and copyright information in PMC

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