[11C]Choline-PET/CT for outcome prediction of salvage radiotherapy of local relapsing prostate carcinoma.
OBJECTIVE
[11C]Choline-positron emission tomography in combination with computer tomography ([11C]Choline-PET/CT) is a promising imaging approach for localizing relapsing prostate cancer. We therefore studied performance of [11C]Choline-PET/CT in patients relapsing from prostate cancer after radical prostatectomy (RP) and scheduled for salvage radiation therapy (SRT) in terms of relapse localization and relationship to outcome after SRT.


METHODS
In a prospective pilot study we examined 27 patients with [11C]Coline-PET/CT before SRT. All patients had biochemical relapse after RP and were treated with SRT. [11C]Choline-PET/CT was done within 14 days before SRT.


RESULTS
Eleven of 27 patients had at follow up of 76.5±5.7 months a favorable long-term response to SRT and needed no specific further prostate cancer related treatment. In 16/27 patients, rising serum PSA concentrations were observed 34.2±20.1 months after SRT, qualifying them as treatment failures. Tumor stage, risk profile and PSA before SRT were not different in long term responders and failures. [11C]Choline-PET/CT showed local relapse in about 50% of both long-term responders failures, locoregional nodal relapse in 4/16 failures and a singular bone metastasis in 1/16 failures.


CONCLUSIONS
[11C]Choline-PET/CT showed in roughly 50% of patients evidence of local relapse within the prostatic fossa. Roughly 30% of treatment failures had evidence of locoregional nodal or distant metastatic disease outside the radiation ports possibly related to treatment failures after SRT. Kaplan-Meier analysis suggested that [11C]Choline-PET/CT positive patients do worse at follow-up in terms of freedom from biochemical recurrence.
Department of Nuclear Medicine, University Clinic, Ulm, Germany. sven.reske@uniklinik-ulm.de
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Reske
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Moritz
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Kull
D000368:Aged; D000369:Aged, 80 and over; D002250:Carbon Radioisotopes; D002794:Choline; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D049268:Positron-Emission Tomography; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D019275:Radiopharmaceuticals; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed
D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline