title: Role of ¹¹C-choline positron emission tomography/computed tomography in evaluating patients affected by prostate cancer with suspected relapse due to prostate-specific antigen elevation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the accuracy of (11)C-choline positron emission tomography/computed tomography (PET/CT) in restaging patients affected by prostate cancer and suspected relapse due to prostate-specific antigen (PSA) increase. We also aimed to determine a PSA cutoff that is most suited to the study in terms of best compromise between sensitivity and specificity. Secondary endpoints were a comparison between (11)C-choline PET/CT and histological results, clinical findings, and radiological imaging (CT and magnetic resonance imaging).
  
  
  METHODS
  We retrospectively evaluated 210 patients (median ± SD age 70 ± 7 years) affected by prostate cancer who underwent (11)C-choline PET/CT.
  
  
  RESULTS
  (11)C-choline PET/CT imaging was positive in 116 (55.2%) patients and negative in 94 (44.8%). Receiver operating characteristic (ROC) analysis showed that the highest accuracy (sensitivity 76.8%, specificity 92.5%) for the whole population was achieved when the PSA level of 1.26 ng/ml level was used as the cutoff value for interpreting the results (P = 0.0001 and the area under the ROC curve AUC 0.897). For patients treated with surgery or surgery plus radiotherapy the cutoff was 0.81 ng/ml (sensitivity 73.2%, specificity 86.1%). For patients treated with radiotherapy alone, the cutoff was 2.0 ng/ml (sensitivity 81.8%, specificity 92.9%).
  
  
  CONCLUSIONS
  Our results indicate that (11)C-choline PET/CT is a useful diagnostic tool in patients affected by prostate cancer and a relapsed PSA level. The highest accuracy for all patients is obtained with a PSA cutoff level of 1.26 ng/ml, above which the imaging study is performed (0.81 ng/ml for patients treated with surgery or surgery plus radiotherapy and 2.0 ng/ml for patients treated with radiotherapy alone).
authors.affiliation: Department of Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili 1, Brescia 25123, Italy. francesco.bertagna@spedalicivili.brescia.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Bertagna
authors.forename: Muhannad
authors.initials: M
authors.lastname: Abuhilal
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bosio
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Rossini
authors.forename: Claudio
authors.initials: C
authors.lastname: Pizzocaro
authors.forename: Emanuela
authors.initials: E
authors.lastname: Orlando
authors.forename: Marco
authors.initials: M
authors.lastname: Finamanti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Biasiotto
authors.forename: Carlo
authors.initials: C
authors.lastname: Rodella
authors.forename: Sergio
authors.initials: S
authors.lastname: Cosciani Cunico
authors.forename: Raffaele
authors.initials: R
authors.lastname: Giubbini
mesh_terms: D000368:Aged; D002794:Choline; D003287:Contrast Media; D023381:Endpoint Determination; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D009942:Organometallic Compounds; D049268:Positron-Emission Tomography; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D017430:Prostate-Specific Antigen; D002794:Choline