[11C]choline positron emission tomography/computerized tomography to restage prostate cancer cases with biochemical failure after radical prostatectomy and no disease evidence on conventional imaging.
OBJECTIVE
We assessed the value of [11C]choline positron emission tomography/computerized tomography in patients with prostate cancer in whom biochemical failure developed after radical prostatectomy but who showed no disease evidence on conventional imaging.


METHODS
Considered for this study were 2,124 patients treated with radical prostatectomy who underwent [11C]choline positron emission tomography/computerized tomography to restage disease between December 2004 and January 2007. Study inclusion criteria were 1) previous radical prostatectomy and pelvic lymph node dissection, 2) increasing prostate specific antigen beyond 0.2 ng/ml after radical prostatectomy, 3) no lymph node disease at radical prostatectomy, 4) no evidence of metastatic disease on conventional imaging, 5) no androgen deprivation therapy and 6) no adjuvant or salvage radiotherapy. These criteria were satisfied in 109 of the 2,124 patients (5%).


RESULTS
Median prostate specific antigen at imaging was 0.81 ng/ml (range 0.22 to 16.76 ml). Imaging suggested local recurrence in 4 patients (4%) and pelvic lymph node disease in 8 (7%). Scans were positive in 5%, 15% and 28% of patients with prostate specific antigen less than 1, between 1 and 2, and greater than 2 ng/ml, respectively (p <0.05). Prostate specific antigen was the only significant predictor of tomography results (p <0.05).


CONCLUSIONS
Positron emission tomography/computerized tomography detected increased [11C]choline uptake, suggesting recurrent disease in 11% of patients with prostate cancer, increasing prostate specific antigen after radical prostatectomy and no evidence of disease on conventional imaging. This modality may be useful to restage disease but it cannot be used to guide therapy.
Giovacchini
Giampiero
G
Center for Molecular Bioimaging, University of Milano-Bicocca, Milan, Italy.
Picchio
Maria
M
Briganti
Alberto
A
Cozzarini
Cesare
C
Scattoni
Vincenzo
V
Salonia
Andrea
A
Landoni
Claudio
C
Gianolli
Luigi
L
Di Muzio
Nadia
N
Rigatti
Patrizio
P
Montorsi
Francesco
F
Messa
Cristina
C
D000368:Aged; D000369:Aged, 80 and over; D002794:Choline / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
C447081:methyl carbon-11 choline; D002794:Choline