title: Prognostic value of metabolic parameters and clinical impact of ¹⁸F-fluorocholine PET/CT in biochemical recurrent prostate cancer.
abstract: OBJECTIVE
  To evaluate the therapeutic impact of (18)F-fluorocholine (FCH) PET/CT in biochemical recurrent prostate cancer (PC) and to investigate the value of quantitative FCH PET/CT parameters in predicting progression-free survival (PFS).
  
  
  METHODS
  This retrospective study included 172 consecutive patients with PC who underwent FCH PET/CT for biochemical recurrence. Mean rising PSA was 10.7 ± 35.0 ng/ml. Patients with positive FCH PET were classified into three groups: those with uptake only in the prostatic bed, those with locoregional disease, and those with distant metastases. Referring physicians were asked to indicate the hypothetical therapeutic strategy with and without the FCH PET/CT results. Clinical variables and PET parameters including SUVmax, SUVpeak, SUVmean, total lesion choline kinase activity (TLCKA) and standardized added metabolic activity (SAM) were recorded and a multivariate analysis was performed to determine the factors independently predicting PFS.
  
  
  RESULTS
  In 137 of the 172 patients, the FCH PET/CT scan was positive, and of these, 29.9 % (41/137) had prostatic recurrence, 42.3 % (58/137) had pelvic lymph node recurrence with or without prostatic recurrence, and 27.7 % (38/137) had distant metastases. The FCH PET/CT result led to a change in treatment plan in 43.6 % (75/172) of the 172 patients. Treatment was changed in 49.6 % (68/137) of those with a positive FCH PET/CT scan and in 20 % (7/35) of those with a negative FCH PET/CT scan. After a median follow-up of 29.3 months (95 % CI 18.9 - 45.9 months), according to multivariate analysis age <70 years, SAM ≥23 and SUVmean ≥3 were parameters independently predicting PFS. A nomogram constructed using the three parameters showed 49 months of PFS in patients with the best scores (0 or 1) and only 11 months in patients with a poor score (score 3).
  
  
  CONCLUSIONS
  This study indicates that a positive FCH PET result in PC patients with biochemical recurrence predicts a shorter PFS and confirms the major impact of the FCH PET result on the management of biochemical recurrent PC.
authors.affiliation: Nuclear Medicine, Institut de Cancérologie de l'Ouest René Gauducheau, Boulevard Jacques Monod, 44805 Nantes-St Herblain Cedex, France. mathilde.colombie@ico.unicancer.fr.
authors.forename: M
authors.initials: M
authors.lastname: Colombié
authors.affiliation: Statistics, ICO Cancer Center, Saint-Herblain, France.|Nantes-Angers Cancer Research Center, INSERM U892-CNRS UMR 6299, Nantes University, Nantes, France.
authors.forename: L
authors.initials: L
authors.lastname: Campion
authors.affiliation: Nuclear Medicine, Institut de Cancérologie de l'Ouest René Gauducheau, Boulevard Jacques Monod, 44805 Nantes-St Herblain Cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Bailly
authors.affiliation: Nuclear Medicine, Institut de Cancérologie de l'Ouest René Gauducheau, Boulevard Jacques Monod, 44805 Nantes-St Herblain Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Rusu
authors.affiliation: Urologic Clinic Nantes-Atlantis, Saint Herblain, France.
authors.forename: T
authors.initials: T
authors.lastname: Rousseau
authors.affiliation: Nuclear Medicine, University Hospital, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Mathieu
authors.affiliation: Physics, ICO Cancer Center, Saint-Herblain, France.
authors.forename: L
authors.initials: L
authors.lastname: Ferrer
authors.affiliation: Nuclear Medicine, Institut de Cancérologie de l'Ouest René Gauducheau, Boulevard Jacques Monod, 44805 Nantes-St Herblain Cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Rousseau
authors.affiliation: Nuclear Medicine, Institut de Cancérologie de l'Ouest René Gauducheau, Boulevard Jacques Monod, 44805 Nantes-St Herblain Cedex, France.|Nuclear Medicine, University Hospital, Nantes, France.|Nantes-Angers Cancer Research Center, INSERM U892-CNRS UMR 6299, Nantes University, Nantes, France.
authors.forename: F
authors.initials: F
authors.lastname: Kraeber-Bodéré
authors.affiliation: Nuclear Medicine, Institut de Cancérologie de l'Ouest René Gauducheau, Boulevard Jacques Monod, 44805 Nantes-St Herblain Cedex, France.|Nantes-Angers Cancer Research Center, INSERM U892-CNRS UMR 6299, Nantes University, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Rousseau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002794:Choline / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: C514960:fluorocholine; D002794:Choline
keywords: 18F-Choline; Biochemical recurrence; Metabolic parameters; PET/CT; Prostate cancer