title: FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade prostate cancer at biopsy.
abstract: BACKGROUND
  The role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in prostate cancer (PCa) has not been well defined yet. Because high-grade PCa tends to exhibit increased glycolytic rate, FDG-PET/CT could be useful in this setting. The aim of this study was to assess the value of FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade PCa at biopsy.
  
  
  METHODS
  Fifty-four patients with a Gleason sum≥8 PCa at biopsy underwent FDG-PET/CT as part of the staging workup. Thirty-nine patients underwent radical prostatectomy (RP) and pelvic lymph node (LN) dissection, 2 underwent LN dissection only, and 13 underwent non-surgical treatments. FDG-PET/CT findings from clinical reports, blinded reading and quantitative analysis were correlated with clinico-pathological characteristics at RP.
  
  
  RESULTS
  Suspicious foci of increased FDG uptake were found in the prostate, LNs and bones in 44, 13 and 6% of patients, respectively. Higher clinical stage, post-RP Gleason sum and pattern, and percentage of cancer involvement within the prostate were significantly associated with the presence of intraprostatic FDG uptake (IPFU) (P<0.05 in all cases). Patients without IPFU who underwent RP were downgraded to Gleason≤7 in 84.6% of cases, as compared to 30.8% when IPFU was reported (P=0.003). Qualitative and quantitative IPFU were significantly positively correlated with post-RP Gleason pattern and sum, and pathological T stage. Absence and presence of IPFU were associated with a median 5-year cancer-free survival probability of 70.2 and 26.9% (P=0.0097), respectively, using the CAPRA-S prognostic tool.
  
  
  CONCLUSIONS
  These results suggest that, among patients with a high-grade PCa at biopsy, FDG-PET/CT could improve pre-treatment prognostic stratification by predicting primary PCa pathological grade and survival probability following RP.
authors.affiliation: Division of Nuclear Medicine, Department of Radiology and Cancer Research Center, Université Laval, Quebec City, Canada. jean-mathieu.beauregard@chuq.qc.ca.|Division of Nuclear Medicine, Department of Medical Imaging and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. jean-mathieu.beauregard@chuq.qc.ca.
authors.forename: Jean-Mathieu
authors.initials: JM
authors.lastname: Beauregard
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. annie-claude.blouin.1@ulaval.ca.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. annie-claude.blouin.1@ulaval.ca.
authors.forename: Annie-Claude
authors.initials: AC
authors.lastname: Blouin
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. vfradet@me.com.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. vfradet@me.com.
authors.forename: Vincent
authors.initials: V
authors.lastname: Fradet
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. Andre.Caron@crchudequebec.ulaval.ca.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. Andre.Caron@crchudequebec.ulaval.ca.
authors.forename: André
authors.initials: A
authors.lastname: Caron
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. Y.Fradet@diagnocure.com.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. Y.Fradet@diagnocure.com.
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.affiliation: Centre hospitalier du Christ-Roi, Quebec City, Canada. annie-claude.blouin.1@ulaval.ca.
authors.forename: Claude
authors.initials: C
authors.lastname: Lemay
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. Louis.Lacombe@crchudequebec.ulaval.ca.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. Louis.Lacombe@crchudequebec.ulaval.ca.
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. th.dujardin@videotron.ca.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. th.dujardin@videotron.ca.
authors.forename: Thierry
authors.initials: T
authors.lastname: Dujardin
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. rbtiguert@yahoo.com.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. rbtiguert@yahoo.com.
authors.forename: Rabi
authors.initials: R
authors.lastname: Tiguert
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. goran.rimac.1@ulaval.ca.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. goran.rimac.1@ulaval.ca.
authors.forename: Goran
authors.initials: G
authors.lastname: Rimac
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. frederick.bouchard.1@ulaval.ca.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. frederick.bouchard.1@ulaval.ca.
authors.forename: Frédérick
authors.initials: F
authors.lastname: Bouchard
authors.affiliation: Division of Urology, Department of Surgery and Cancer Research Center, Université Laval, Quebec City, Canada. frederic.pouliot@crchuq.ulaval.ca.|Division of Urology, Department of Surgery and Oncology Axis of CHU de Québec Research Center, CHU de Québec, Quebec City, Canada. frederic.pouliot@crchuq.ulaval.ca.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pouliot
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000378:metabolism; D000368:Aged; D001842:Bone and Bones / Q000378:metabolism; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology*; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18