title: Significant increase in detection of prostate cancer recurrence following radical prostatectomy with an early imaging acquisition protocol with ¹⁸F-fluorocholine positron emission tomography/computed tomography.
abstract: OBJECTIVE
  To highlight a new imaging acquisition protocol during (18)F-fluorocholine PET/CT in patients with biochemical recurrence after RP.
  
  
  METHODS
  A total of 146 patients with PSA levels between 0.2 and 1 ng/ml with negative conventional imaging who did not receive salvage treatment were prospectively enrolled. Imaging acquisition protocol included an early dynamic phase (1-8 min), a conventional whole body (10-20 min), and a late phase (30-40 min). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured. Univariable and multivariable analyses were performed to identify independent predictors of positive PET/CT.
  
  
  RESULTS
  The median trigger PSA was 0.6 ng/ml (IQR 0.43-0.76). Median PSA doubling time (PSA DT) was 7.91 months (IQR 4.42-11.3); median PSA velocity (PSAV) was 0.02 ng/ml per month (IQR 0.02-0.04). Overall, (18)F-fluorocholine PET/CT was positive in 111 of 146 patients (76 %). Out of 111 positive examinations, 80 (72.1 %) were positive only in the early dynamic phase. Sensitivity, specificity, PPV, NPV, and accuracy were 78.9, 76.9, 97.2, 26.3, and 78.7 %, respectively. At multivariable logistic regression, trigger PSA ≥ 0.6 ng/ml [odds ratio (OR) 3.13; p = 0.001] and PSAV ≥ 0.04 ng/ml per month (OR 4.95; p = 0.004) were independent predictors of positive PET/CT. The low NPV remains the main limitation of PET/CT in this setting of patients.
  
  
  CONCLUSIONS
  The increased sensitivity, thanks to the early imaging acquisition protocol, makes (18)F-fluorocholine PET/CT an attractive tool to detect prostate cancer recurrences in patients with a PSA level <1 ng/ml.
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. puldet@gmail.com.|Department of Urology, "San Giovanni Bosco" Hospital, Turin, Italy. puldet@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Simone
authors.affiliation: Department of Obstetrics, Gynecology and Urology, 'Sapienza' University, Rome, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Di Pierro
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.affiliation: Department of Nuclear Medicine, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sciuto
authors.affiliation: Department of Nuclear Medicine, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rea
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Mariaconsiglia
authors.initials: M
authors.lastname: Ferriero
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Guaglianone
authors.affiliation: Department of Nuclear Medicine, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Carlo Ludovico
authors.initials: CL
authors.lastname: Maini
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Gallucci
mesh_terms: D000368:Aged; D002794:Choline / Q000031:analogs & derivatives* / Q000494:pharmacology; D055088:Early Detection of Cancer / Q000379:methods*; D005462:Fluorine Radioisotopes; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis*; D049268:Positron-Emission Tomography / Q000379:methods*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D005462:Fluorine Radioisotopes; C514960:fluorocholine; D017430:Prostate-Specific Antigen; D002794:Choline
keywords: Biochemical recurrence; Choline; PSA; Positron emission tomography (PET)/computed tomography (CT); Prostate cancer; Radical prostatectomy