title: 11C-acetate PET/CT before radical prostatectomy: nodal staging and treatment failure prediction.
abstract: Despite early detection programs, many patients with prostate cancer present with intermediate- or high-risk disease. We prospectively investigated whether (11)C-acetate PET/CT predicts lymph node (LN) metastasis and treatment failure in men for whom radical prostatectomy is planned.
  
  
  METHODS
  107 men with intermediate- or high-risk localized prostate cancer and negative conventional imaging findings underwent PET/CT with (11)C-acetate. Five underwent LN staging only, and 102 underwent LN staging and prostatectomy. PET/CT findings were correlated with pathologic nodal status. Treatment-failure-free survival was estimated by the Kaplan-Meier method. The ability of PET/CT to predict outcomes was evaluated by multivariate Cox proportional hazards analysis.
  
  
  RESULTS
  PET/CT was positive for pelvic LN or distant metastasis in 36 of 107 patients (33.6%). LN metastasis was present histopathologically in 25 (23.4%). The sensitivity, specificity, and positive and negative predictive values of PET/CT for detecting LN metastasis were 68.0%, 78.1%, 48.6%, and 88.9%, respectively. Treatment failed in 64 patients: 25 with metastasis, 17 with a persistent postprostatectomy prostate-specific antigen level greater than 0.20 ng/mL, and 22 with biochemical recurrence (prostate-specific antigen level > 0.20 ng/mL after nadir) during follow-up for a median of 44.0 mo. Treatment-failure-free survival was worse in PET-positive than in PET-negative patients (P < 0.0001) and in those with false-positive than in those with true-negative scan results (P < 0.01), suggesting that PET may have demonstrated nodal disease not removed surgically or identified pathologically. PET positivity independently predicted failure in preoperative (hazard ratio, 3.26; P < 0.0001) and postoperative (hazard ratio, 3.07; P = 0.0001) multivariate models.
  
  
  CONCLUSIONS
  In patients planned for or completing prostatectomy, (11)C-acetate PET/CT detects LN metastasis not identified by conventional imaging and independently predicts treatment-failure-free survival.
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Haseebuddin
authors.forename: Farrokh
authors.initials: F
authors.lastname: Dehdashti
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.forename: Jingxia
authors.initials: J
authors.lastname: Liu
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Roth
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Nepple
authors.forename: Cary L
authors.initials: CL
authors.lastname: Siegel
authors.forename: Keith C
authors.initials: KC
authors.lastname: Fischer
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Andriole
authors.forename: Tom R
authors.initials: TR
authors.lastname: Miller
mesh_terms: D000085:Acetates; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002244:Carbon; D018572:Disease-Free Survival; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D012306:Risk; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D000085:Acetates; C438206:carbon-11 acetate; D002244:Carbon
keywords: PET; acetate; cancer staging; lymphatic metastasis; prostatic cancer