ABSTRACT
OBJECTIVE: To compare the diagnostic accuracy of PET/CT with (18)F-FDG and (11)C-choline for early detection and localization of recurrent prostate cancer. MATERIAL AND METHODS: Thirty-eight patients with increased PSA levels (0.8-9.5 ng/ml) after radical treatment for prostate cancer (surgery n = 20/radiation therapy n = 18) were included. Ten patients were on hormone therapy. All patients underwent a PET/CT with (11)C-choline and (18)F-FDG, respectively, on the same day. The PET imaging findings were compared with histopathology (n = 10); PSA monitoring (n = 21) and/ or other methods (n = 7). RESULTS: Focal uptake of (11)C-choline was detected in 26 patients (68%), and focal uptake of (18)F-FDG was detected in 13 patients (34%). The (11)C-choline uptake in 14 patients was suggested local recurrence, whereas this was true in only 4 patients (48%) with (18)F-FDG. Pelvic lymph nodes were detected with (11)C-choline PET/CT in 8 patients and only in 4 patients (50%) with (18)F-FDG. Mediastinal involvement was detected in 5 patients with (11)C-choline and 3 patients (60%) with (18)F-FDG. Focal bone involvement was detected in 3 patients with (11)C-choline and (18)F-FDG. (11)C-choline was able to detect 40% of recurrences in patients with PSA < 1 ng/ml, 50% of recurrences in patients with PSA 1-4 ng/ml and 87% of recurrences with PSA > 4 ng/ml. Sensitivity of (11)C-choline was higher for surgically treated patients, with no significant differences found between patients with and without hormone therapy. CONCLUSIONS: (11)C-choline PET/CT was useful for the detection of biochemical recurrence of prostate cancer, with higher yielding as compared to (18)F-FDG. (11)C-choline sensitivity was clearly related to PSA levels, was higher in patients with surgery and did not seem to be modified by hormonal therapy. Disease staging with (11)C-choline showed direct impact for the selection of the most appropriate therapeutic approach.
Subject(s)
Adenocarcinoma/diagnostic imaging , Carbon Radioisotopes , Choline , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Positron-Emission Tomography , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnostic imaging , Radiopharmaceuticals , Tomography, X-Ray Computed , Adenocarcinoma/blood , Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Adenocarcinoma/secondary , Adenocarcinoma/surgery , Aged , Androgen Antagonists/therapeutic use , Antineoplastic Agents, Hormonal/therapeutic use , Bone Neoplasms/blood , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Carbon Radioisotopes/pharmacokinetics , Choline/pharmacokinetics , Combined Modality Therapy , Fluorodeoxyglucose F18/pharmacokinetics , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Recurrence, Local/diagnostic imaging , Postoperative Period , Prostatectomy , Prostatic Neoplasms/blood , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/surgery , Radiopharmaceuticals/pharmacokinetics , Sensitivity and Specificity , Tissue DistributionABSTRACT
Objetivo: Comparar el rendimiento diagnóstico de la PET/TAC con 18F-FDG y 11C-colina en la detección precoz y localización de la recurrencia del cáncer de próstata. Material y métodos: Se incluyeron 38 pacientes con elevación de PSA (0,8-9,5 ng/ml) tras terapia radical de cáncer de próstata (cirugía n = 20/radioterapia n = 18). Diez pacientes estaban en terapia antiandrogénica. A todos se les realizó el mismo día una PET/TAC con 11C-colina y 18F-FDG. Los hallazgos se compararon con la histología (n = 10), monitorización del PSA (n = 21) y/u otras técnicas (n = 7). Objetivo: Comparar el rendimiento diagnóstico de la PET/TAC con 18F-FDG y 11C-colina en la detección precoz y localización de la recurrencia del cáncer de próstata. Material y métodos: Se incluyeron 38 pacientes con elevación de PSA (0,8-9,5 ng/ml) tras terapia radical de cáncer de próstata (cirugía n = 20/radioterapia n = 18). Diez pacientes estaban en terapia antiandrogénica. A todos se les realizó el mismo día una PET/TAC con 11C-colina y 18F-FDG. Los hallazgos se compararon con la histología (n = 10), monitorización del PSA (n = 21) y/u otras técnicas (n = 7). Resultados: El 68% de los pacientes (n = 26) mostraron depósitos de 11C-colina y un 34% (n = 13) focos con 18FFDG. Catorce pacientes mostraron captación de 11C-colina sugestiva de recidiva local, y sólo 6 (48%) de 18F-FDG. La 11C-colina mostró adenopatías pélvicas en 8 pacientes y sólo 4 (50%) con 18F-FDG. La afectación mediastínica se observó en 5 pacientes con 11C-colina y en 3 (60%) con 18F-FDG. Se detectaron depósitos de 18F-FDG y 11C-colina en el esqueleto de 3 pacientes. En el grupo de pacientes con PSA < 1 ng/ml la 11C-colina detectó el 40% de recidivas, con PSA entre 1-4 ng/ml, el 50% y con PSA > 4 ng/ml, el 87%. La sensibilidad de la 11C-colina fue más elevada en los pacientes operados, sin diferencias entre los pacientes con o sin terapia antiandrogénica...(AU)
Objective: To compare the diagnostic accuracy of PET/CT with 18F-FDG and 11C-choline for early detection and localization of recurrent prostate cancer. Material and methods: Thirty-eight patients with increased PSA levels (0.8-9.5 ng/ml) after radical treatment for prostate cancer (surgery n = 20/radiation therapy n = 18) were included. Ten patients were on hormone therapy. All patients underwent a PET/CT with 11C-choline and 18F-FDG, respectively, on the same day. The PET imaging findings were compared with histopathology (n = 10); PSA monitoring (n = 21) and/ or other methods (n = 7). Results: Focal uptake of 11C-choline was detected in 26 patients (68%), and focal uptake of 18F-FDG was detected in 13 patients (34%). The 11C-choline uptake in 14 patients was suggested local recurrence, whereas this was true in only 4 patients (48%) with 18F-FDG. Pelvic lymph nodes were detected with 11C-choline PET/CT in 8 patients and only in 4 patients (50%) with 18FFDG. Mediastinal involvement was detected in 5 patients with 11C-choline and 3 patients (60%) with 18F-FDG. Focal bone involvement was detected in 3 patients with 11C-choline and 18F-FDG. 11C-choline was able to detect 40% of recurrences in patients with PSA < 1 ng/ml, 50% of recurrences in patients with PSA 1-4 ng/ml and 87% of recurrences with PSA > 4 ng/ml. Sensitivity of 11C-choline was higher for surgically treated patients, with no significant differences found between patients with and without hormone therapy. Conclusions: 11C-choline PET/CT was useful for the detection of biochemical recurrence of prostate cancer, with higher yielding as compared to 18F-FDG. 11C-choline sensitivity was clearly related to PSA levels, was higher in patients with surgery and did not seem to be modified by hormonal therapy. Disease staging with 11C-choline showed direct impact for the selection of the most appropriate therapeutic approach(AU)
