title: [¹¹C]Choline PET/CT predicts survival in hormone-naive prostate cancer patients with biochemical failure after radical prostatectomy.
abstract: OBJECTIVE
  Over the last decade, PET/CT with radiolabelled choline has been shown to be useful for restaging patients with prostate cancer (PCa) who develop biochemical failure. The limitations of most clinical studies have been poor validation of [(11)C]choline PET/CT-positive findings and lack of survival analysis. The aim of this study was to assess whether [(11)C]choline PET/CT can predict survival in hormone-naive PCa patients with biochemical failure.
  
  
  METHODS
  This retrospective study included 302 hormone-naive PCa patients treated with radical prostatectomy who underwent [(11)C]choline PET/CT from 1 December 2004 to 31 July 2007 because of biochemical failure (prostate-specific antigen, PSA, >0.2 ng/mL). Median PSA was 1.02 ng/mL. PCa-specific survival was estimated using Kaplan-Meier curves. Cox regression analysis was used to evaluate the association between clinicopathological variables and PCa-specific survival. The coefficients of the covariates included in the Cox regression analysis were used to develop a novel nomogram.
  
  
  RESULTS
  Median follow-up was 7.2 years (1.4 - 18.9 years). [(11)C]Choline PET/CT was positive in 101 of 302 patients (33%). Median PCa-specific survival after prostatectomy was 14.9 years (95% CI 9.7 - 20.1 years) in patients with positive [(11)C]choline PET/CT. Median survival was not achieved in patients with negative [(11)C]choline PET/CT. The 15-year PCa-specific survival probability was 42.4% (95% CI 31.7 - 53.1%) in patients with positive [(11)C]choline PET/CT and 95.5% (95% CI 93.5 - 97.5 %) in patients with negative [(11)C]choline PET/CT. In multivariate analysis, [(11)C]choline PET/CT (hazard ratio 6.36, 95% CI 2.14 - 18.94, P < 0.001) and Gleason score >7 (hazard ratio 3.11, 95% CI 1.11 - 8.66, P = 0.030) predicted PCa-specific survival. An internally validated nomogram predicted 15-year PCa-specific survival probability with an accuracy of 80%.
  
  
  CONCLUSIONS
  Positive [(11)C]choline PET/CT after biochemical failure predicts PCa-specific survival in hormone-naive PCa patients. Prospective studies are warranted to confirm our results before more extensive use of [(11)C]choline PET/CT for prognostic stratification of PCa patients.
authors.affiliation: Department of Radiology and Nuclear Medicine, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Giovacchini
authors.forename: Elena
authors.initials: E
authors.lastname: Incerti
authors.forename: Paola
authors.initials: P
authors.lastname: Mapelli
authors.forename: Margarita
authors.initials: M
authors.lastname: Kirienko
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Luigi
authors.initials: L
authors.lastname: Gianolli
authors.forename: Maria
authors.initials: M
authors.lastname: Picchio
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery; D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery; D019275:Radiopharmaceuticals; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D017430:Prostate-Specific Antigen; D002794:Choline