title: Evaluation of [11C]-choline positron-emission/computed tomography in patients with increasing prostate-specific antigen levels after primary treatment for prostate cancer.
abstract: OBJECTIVE
  To evaluate [(11)C]-choline positron-emission tomography (PET)/computed tomography (CT) for detecting clinical recurrence after primary treatment for prostate cancer.
  
  
  METHODS
  In all, 50 patients with prostate cancer who had had initial therapy (radical prostatectomy in 40, external beam radiation in three and interstitial brachytherapy in seven) had PET/CT using [(11)C]-choline in the presence of an increased or increasing prostate-specific antigen (PSA) level. The mean (range) time to biochemical progression was 22 (2-136) months. Current PSA levels were determined in all patients at the time of examination. The results were correlated with the histopathology reports after targeted biopsy or surgery, and with the clinical follow-up.
  
  
  RESULTS
  The mean (median, range) PSA level in patients with positive PET/CT was 3.62 (2.42, 0.5-13.1) ng/mL, and that in patients with a negative scan was 0.90 (0.95, 0.41-1.40) ng/mL. PET/CT was positive in seven of 13 patients with a PSA level of <1.5 ng/mL, and histology was positive in this group in nine. In 17 patients with PSA levels of 1.5-2.5 ng/mL PET/CT was positive in all and the histology was positive in 13; in 11 men with a PSA level of 2.5-5 ng/mL PET/CT was positive in all 11 and the histology was positive in 10; in nine men with PSA levels of >5 ng/mL PET/CT identified all as positive and the histology was positive in eight. The sensitivity at a PSA level of <2.5 ng/mL of PET/CT for detecting recurrence was 91% (95% confidence interval, 71-99%) with a specificity of 50% (16-84)%.
  
  
  CONCLUSIONS
  [(11)C]-choline PET/CT seems to be useful for re-staging prostate cancer after curative therapy and with increasing PSA levels; this was verified by histological examination. We recommend this method at PSA levels of <2.5 ng/mL.
authors.affiliation: Department of Urology, University of Ulm, Ulm, Germany. ludwig.rinnab@uniklinik-ulm.de
authors.forename: Ludwig
authors.initials: L
authors.lastname: Rinnab
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: Norbert M
authors.initials: NM
authors.lastname: Blumstein
authors.forename: Sven N
authors.initials: SN
authors.lastname: Reske
authors.forename: Richard E
authors.initials: RE
authors.lastname: Hautmann
authors.forename: Kathrin
authors.initials: K
authors.lastname: Hohl
authors.forename: Peter
authors.initials: P
authors.lastname: Möller
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
authors.forename: Rainer
authors.initials: R
authors.lastname: Kuefer
authors.forename: Juergen E
authors.initials: JE
authors.lastname: Gschwend
mesh_terms: D000368:Aged; D002794:Choline; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000592:standards*