title: 11C-choline PET/CT predicts prostate cancer-specific survival in patients with biochemical failure during androgen-deprivation therapy.
abstract: Several studies have shown that (11)C-choline PET/CT may be useful for restaging prostate cancer (PCa) patients with biochemical failure after radical prostatectomy. However, validation of (11)C-choline PET/CT findings scarcely relied on histologic findings, and prognostic implications of (11)C-choline PET/CT are currently unknown. The aim of this study was to assess whether (11)C-choline PET/CT predicts survival in PCa patients.
  
  
  METHODS
  This retrospective study included 195 PCa patients treated with radical prostatectomy who underwent (11)C-choline PET/CT from December 1, 2004, to July 31, 2007, due to biochemical failure (prostate-specific antigen > 0.2 mg/mL) during androgen-deprivation therapy. PCa-specific survival was computed as the interval from radical prostatectomy to PCa-specific death.
  
  
  RESULTS
  The median interval after radical prostatectomy was 8.9 y (95% confidence interval [CI], 1.7-18.9 y). The median follow-up after (11)C-choline PET/CT was 4.5 y (95% CI, 0.4-8.5 y). (11)C-choline PET/CT results were positive in 57% of patients. The median PCa-specific survival was 16.4 y (95% CI, 14.0-18.8 y) in patients with negative (11)C-choline PET/CT results and 11.2 y (95% CI, 9.8-12.6 y) in patients with positive (11)C-choline PET/CT results (log-rank: χ(2) = 19.3, P < 0001). At multivariate analysis, statistical significance was obtained for (11)C-choline PET/CT (hazard ratio, 2.53; 95% CI, 1.41-4.53; P = 0.002), prostate-specific antigen (hazard ratio, 1.03; 95% CI, 1.00-1.05; P = 0.037), and Gleason score (>7: hazard ratio, 2.49; 95% CI, 1.25-4.95; P = 0.009). Patients with pathologic (11)C-choline uptake in the prostatic bed or in pelvic or retroperitoneal lymph nodes had longer PCa-specific survival (median, 12.1 y; 95% CI, 10.5-13.7 y) in comparison to patients with pathologic tracer uptake in the skeleton (median, 9.9 y; 95% CI, 6.8-13.1 y) (log-rank: χ(2) = 6.5, P = 0.010). Two internally validated nomograms predicted 10- and 15-y PCa-specific survival probability with an accuracy of 76% and 74%, respectively. In an ancillary analysis, we also showed that (11)C-choline PET/CT predicts PCa-specific survival after PET/CT, with similar statistical power.
  
  
  CONCLUSIONS
  (11)C-choline PET/CT predicts PCa-specific survival in PCa patients treated with radical prostatectomy who develop biochemical failure during androgen-deprivation therapy. If independent or multicenter confirmation of these findings is obtained, (11)C-choline PET/CT might be more widely used in the follow-up of PCa patients for tailoring salvage therapy.
authors.affiliation: Department of Radiology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Giovacchini
authors.forename: Maria
authors.initials: M
authors.lastname: Picchio
authors.forename: Rita
authors.initials: R
authors.lastname: Garcia-Parra
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Luigi
authors.initials: L
authors.lastname: Gianolli
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Fazio
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D002250:Carbon Radioisotopes; D002794:Choline; D018572:Disease-Free Survival; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D049268:Positron-Emission Tomography / Q000379:methods*; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D002250:Carbon Radioisotopes; D002794:Choline
keywords: 11C-choline PET/CT; PCa-specific survival; biochemical failure