11C-Choline Pet/Ct in the Detection of Prostate Cancer Relapse in Patients After Radical Treatment With Psa Level < 10 Ng/Ml
Abstract
Purpose: To evaluate the usefulness of 11C-Choline PET/CT in the detection of recurrent prostate cancer (PCa) in patients with biochemical relapse after radical treatment. Materials and methods: This retrospective study included 217 PCa patients who underwent 11C-Choline PET/CT in the Department of Nuclear Medicine of Bakoulev Scientific Centre. All patients had biochemical relapse 3±2 years after radical treatment for locally advanced PCa (T1–3 N0–1 M0): radical prostatectomy (n = 159) and radiation therapy (n = 58). The mean PSA value in the group was 2.1±2.5 (0.2–9.7) ng/ml, median – 1.9 ng/ml. Imaging was performed on PET/CT scanner (Biograph-64, Siemens) 10 min after injection of 11C-Choline (400–550 Mbq).
Results: Overall, according to 11C-Choline PET/CT results PCa relapse was detected in 56% (121/217) of cases: in 50% (80/159) after radical prostatectomy and in 71% (41/58) after radiation therapy. The mean PSA value in PET-positive cases was 3.1±2.2 (0.2–9.7) ng/ml, while in PETnegative cases – 1.8±1.7 (0.2–4.6) ng/ml. The majority – 68% (65/96) patients with PET-negative scan had low PSA levels (< 2 ng/ml). PET/CT results were positive in 43% (50/115) patients with PSA of < 2 ng/ml, in 63% (45/72) with PSA of 2 to 5 ng/ml, and in 87% (26/30) with PSA of > 5 ng/ml. Local relapse was detected in 51% (62/121) patients, distant metastases – in 28% (34/121) of cases, both local and distant metastases – in 21% (25/121) of cases. Lymph node metastases were detected in 38% (86/217) of all patients included in the analysis, of which 28% (24/86) had lesions in lymph node of normal size (median 7 mm). Of all PET-positive patients bone metastases were detected in 33% (40/121), of which 60% (24/40) had isolated skeletal involvement. Importantly, that 27% (11/40) of PETpositive patients with bone metastases had no structural abnormalities on CT images (CT-negative cases), corresponding to isolated involvement of bone marrow. And half of these CT-negative patients (5/11) had single lesions. The mean PSA value in patients with bone metastases was 5.0±3.7 (0.4–9.1) ng/ml, median – 3.8 ng/ml. According to 11C-Choline PET/CT results oligometastatic PCa recurrence was revealed in 38% (82/217) of all patients, of which 62% (51/82) had local relapse only. Distant oligometastatic lesions were detected in 38% (31/82), of which 13% (4/31) were presented by normal-size lymph nodes and 19% (6/31) – by early bone marrow metastases. 48% (58/121) of PET-positive results were confirmed by data of repeated PET/CT examinations. Conclusion: 11C-Choline PET/CT has been shown to be a single noninvasive accurate technique for detection of recurrent PCa in patients with rising PSA after radical treatment, which allows to differentiate patients with local and distant metastases in one study, as well as identify oligometastatic process, and therefore was useful in determining the further personalized therapeutic approach.
Keywords: prostate cancer, PET/CT, 11C-Choline, biochemical recurrence, PSA.
References
[1] Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2016 // CA Cancer J Clin. – 2016; 66(1): 7–30.
[2] Kaprin A.D. Starinskyj V.V., Petrova G.V. Malignant tumors in Russia in 2012 (morbidity and mortality). Moscow, MORI P. Herzen, 2014. 250 p. (in Russian).
[3] Mottet N., Bellmunt J., Briers E., Bolla M., Bourke L., Cornford P. et al. EAU guidelines on prostate cancer. Update March 2017. European Association of Urology. Available at: http://www.uroweb.org/guidelines/onlineguidelines/.
[4] Parker C., Gillessen S., Hendenreich A., Horwich A. ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of prostate cancer // Ann Oncol. – 2015; 26 (Suppl.5): v69–v77.
[5] Punnen S., Cooperberg M.R., D’Amico A.V., Karakiewicz P.I., Moul J.W., Scher H.I. et al. Management of biochemical recurrence after primary treatment of prostate cancer: a systematic review of the literature // Eur Urol. – 2013; 64 (6): 905–15.
[6] Ost P., Bossi A., Decaestecker K., De Meerleer G., Giannarini G., Karnes R.J. Metastasisdirected therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature // Eur Urol. – 2015. – Vol. 67, N 5. – P. 852–63.
[7] Castellucci P., Fanti S. Prostate cancer: identifying sites of recurrence with choline- PET-CT imaging // Nat Rev Urol. – 2015; 12 (3): 134–5.
[8] Fanti S., Minozzi S., Castellucci P., Balduzzi S., Herrmann K., Krause B.J., et al. PET/CT with (11)C-choline for evaluation of prostate cancer patients with biochemical recurrence:meta-analysis and critical review of available data // Eur J Nucl Med Mol Imaging. – 2016; 43 (1): 55–69.
[9] Rodado-Marina S., Coronado-Poggio M., García-Vicente A.M., Alonso-Farto J.C., de la Jara A.C., Maldonado-Suárez A. et al. Clinical utility of (18) F-fluorocholine positron-emission tomography/computed tomography (PET/CT) in biochemical relapse of prostate cancer after radical treatment: results of a multicentre study // BJU Int. – 2015; 115 (6): 874–83.
[10] Chondrogiannis S., Marzola M.C., Grassetto G., Rampin L., Massaro A., Colletti P.M., Rubello D. Optimized protocol for (18)F-choline PET/CT in patients with biochemically relapsed prostate cancer: experiences on 250 consecutive cases //Clin Nucl Med. – 2015; 40 (6): e308–12.
[11] Rybalov M., Breeuwsma A.J., Leliveld A.M., Pruim J., Dierckx R.A., de Jong I.J. Impact of total PSA, PSA doubling time and PSA velocity on detection rates of 11C-Choline positron emission tomography in recurrent prostate cancer. // World J Urol. – 2013; 31 (2): 319–323.
[12] Beheshti M., Haim S., Zakavi R., Steinmair M., Waldenberger P., Kunit T. Et al. Impact of 18 F-choline PET/CT in prostate cancer patients with biochemical recurrence: influence of androgen deprivation therapy and correlation with PSA kinetics // J Nucl Med. – 2013; 54 (6): 833–840.
[13] Detti B., Scoccianti S., Franceschini D., Cipressi S., Cassani S., Villari D. et al. Predictive factors of [18F]-Choline PET/CT in 170 patients with increasing PSA after primary radical treatment // J Cancer Res Clin Oncol. – 2013; 139 (3): 521–528.
[14] Graziani T., Ceci F., Castellucci P., Polverari G., Lima G.M., Lodi F. et al. 11CCholine PET/CT for restaging prostate cancer. Results from 4,426 scans in a singlecentre patient series // Eur J Nucl Med Mol Imaging. – 2016. – [Epub ahead of print].
[15] Von Eyben F. E., Kairemo K. Metaanalysis of 11C-choline and 18F-choline PET/CT for management of patients with prostate cancer. // Nucl Med Commun. – 2014; 35 (3): 221–30.
[16] Marzola M.C., Chondrogiannis S., Ferretti A., Grassetto G., Rampin L., Massaro A. et al. Role of 18F-choline PET/CT in biochemically relapsed prostate cancer after radical prostatectomy: correlation with trigger PSA, PSA velocity, PSA doubling time, and metastatic distribution // Clin Nucl Med. – 2013; 38 (1): e26–32.
[17] Lépinoy A., Cochet A., Cueff A., Cormier L., Martin E., Maingon P. et al. Pattern of occult nodal relapse diagnosed with (18)F-fluoro-choline PET/CT in prostate cancer patients with biochemical failure after prostate-only radiotherapy // Radiother Oncol. – 2014; 111 (1): 120–5.
[18] Ceci F., Castellucci P., Graziani T., Schiavina R., Brunocilla E., Mazzarotto R. et al. 11CCholine PET/CT detects the site of relapse in the majority of prostate cancer patients showing biochemical recurrence after EBRT // Eur J Nucl Med Mol Imaging. – 2014; 41(5): 878–86.
[19] Aslanidis I.P., Pursanova D.M., Mukhortova O.V., Silchenkov A.V., Roshin D.A., Koryakin A.V. et al. 11C–Choline PET / CT in the detection of prostate cancer relapse in patients with rising PSA // Cancerurology. – 2015. – Vol. 11, N 3. – P. 79–86 (in Russian).
[20] Castellucci P., Fuccio C., Nanni C. et al. Influence of trigger PSA and PSA kinetics on 11C-Choline PET/ CT detection rate in patients with biochemical relapse after radical prostatectomy. // J Nucl Med. – 2009; 50 (9): 1394–400.
[21] Giovacchini G., Picchio M., Coradeschi E., Bettinardi V., Gianolli L., Scattoni V. et al. Predictive factors of [11C] Choline PET/CT in patients with biochemical failure after radical prostatectomy // Eur J Nucl Med Mol Imaging. – 2010; 37 (2): 301–9.
[22] Aslanidis I.P., Pursanova D.M., Mukhortova O.V., Katunina T.A., Shirokorad V.I., Roshchin D.A. 11C-Choline PET/CT in recurrence detection in surgically treated prostate cancer patients with low PSA level // REJR. – 2016; 6 (2): 60–71. (in Russian).
[23] Mamede M., Ceci F., Castellucci P., Schiavina R., Fuccio C., Nanni C. et al. The role of 11 C-choline pet imaging in the early detection of recurrence in surgically treated prostate cancer pa-tients with very low PSA level < 0.5 ng/mL. // Clin Nucl Med. – 2013; 38 (9): 342–45.
[24] Kjolhede H., Ahlgren G., Almquist H., Liedberg F., Lyttkens K., Ohlsson T., Bratt O. 18F-choline PET/CT for early detection of metastases in biochemical recurrence following radical pros-tatectomy // World J Urol. – 2015; 33 (11): 1749–52.
[25] Von Eyben F. E., Kairemo K. Metaanalysis of 11C-choline and 18F-choline PET/CT for management of patients with prostate cancer. // Nucl Med Commun. – 2014; 35 (3): 221–30.
[26] Marzola M.C., Chondrogiannis S., Ferretti A., Grassetto G., Rampin L., Massaro A. et al. Role of 18F-choline PET/CT in biochemically relapsed prostate cancer after radical prostatectomy: correlation with trigger PSA, PSA velocity, PSA doubling time, and metastatic distribution // Clin Nucl Med. – 2013; 38 (1): e26–32.
[27] Fuccio C., Castellucci P., Schiavina R., Guidalotti P.L., Gavaruzzi G., Montini G.C. et al. Role of 11C-choline PET/CT in the re-staging of prostate cancer patients withbiochemical relapse and negative results at bone scintigraphy // Eur J Radiol. – 2012; 81 (8): 893–6.
[28] Garcia J.R., Moreno C., Valls E., Cozar P., Bassa P., Soler M. et al. Diagnostic performance of bone scintigraphy and (11)C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer // Rev Esp Med Nucl Imagen Mol. – 2015; 34 (3): 155–61.
[29] Ceci F., Castellucci P., Graziani T., Schiavina R., Chondrogiannis S., Bonfiglioli R. et al. 11C-choline PET/CT identifies osteoblastic and osteolytic lesions in patients with metastatic prostate cancer // Clin Nucl Med. – 2015; 40 (5): e265–70.