title: (11)C-acetate PET/CT in pre-therapeutic lymph node staging in high-risk prostate cancer patients and its influence on disease management - a retrospective study.
abstract: BACKGROUND
  Radiation treatment with simultaneous integrated boost against suspected lymph node metastases may be a curative therapeutic option in patients with high-risk prostate cancer (>15% estimated risk of pelvic lymph node metastases according to the Cagiannos nomogram). (11)C-acetate positron emission tomography/computed tomography (PET/CT) can be used for primary staging as well as for detection of suspected relapse of prostate cancer. The aims of this study were to evaluate the association between positive (11)C-acetate PET/CT findings and the estimated risk of pelvic lymph node metastases and to assess the impact of (11)C-acetate PET/CT on patient management in high-risk prostate cancer patients.
  
  
  METHODS
  Fifty consecutive prostate cancer patients referred for primary staging with (11)C-acetate PET/CT prior to radiotherapy with curative intention were enrolled in this retrospective study.
  
  
  RESULTS
  All patients showed increased (11)C-acetate uptake in the prostate. Pelvic lymph node uptake was seen in 42% (21/50) of the patients, with positive external iliac lymph nodes in 71% (15/21) of these. The overall observed proportion of PET/CT-positive pelvic lymph nodes at patient level was higher than the average estimated risk, especially in low-risk groups (<15%). There was a significant association between observed proportion and estimated risk of pelvic lymph node metastases in groups with ≤45 and >45% estimated risk. Treatment strategy was altered due to (11)C-acetate PET/CT findings in 43% (20/47) of the patients.
  
  
  CONCLUSIONS
  The observed proportion of (11)C-acetate PET/CT findings suggestive of locoregional metastases was higher than the estimated risk, suggesting that the Cagiannos nomogram underestimates the risk for metastases. The imaging results with (11)C-acetate PET/CT have a considerable impact on patient management.
authors.affiliation: Department of Radiation Sciences, Umeå University, 90185, Umeå, Sweden, sara.strandberg@vll.se.
authors.forename: Sara
authors.initials: S
authors.lastname: Strandberg
authors.forename: Camilla Thellenberg
authors.initials: CT
authors.lastname: Karlsson
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Sundström
authors.forename: Mattias
authors.initials: M
authors.lastname: Ögren
authors.forename: Margareta
authors.initials: M
authors.lastname: Ögren
authors.forename: Jan
authors.initials: J
authors.lastname: Axelsson
authors.forename: Katrine
authors.initials: K
authors.lastname: Riklund