title: Whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) vs choline-positron emission tomography-computed tomography (choline-PET/CT) for selecting treatments in recurrent prostate cancer.
abstract: OBJECTIVE
  To determine the effectiveness of whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) in detecting metastases by comparing the results with those from choline-positron emission tomography-computed tomography (choline-PET/CT) in patients with biochemical relapse after primary treatment, and no metastases in bone scintigraphy, CT and/or pelvic MRI, or metastatic/oligometastatic prostate cancer (PCa). Patients with this disease profile who could benefit from treatment with stereotactic body radiation therapy (SBRT) were selected and their responses to these techniques were rated.
  
  
  METHODS
  This was a prospective, controlled, unicentric study, involving 46 consecutive patients from our centre who presented biochemical relapse after adjuvant, salvage or radical treatment with external beam radiotherapy, or brachytherapy. After initial tests (bone scintigraphy, CT, pelvic MRI), 35 patients with oligometastases or without them were selected. 11 patients with multiple metastases were excluded from the study. WB-DW-MRI and choline-PET/CT was then performed on each patient within 1 week. The results were interpreted by specialists in nuclear medicine and MRI. If they were candidates for treatment with ablative SBRT (SABR), they were then evaluated every three months with both tests.
  
  
  RESULTS
  Choline-PET/CT detected lesions in 16 patients that were not observable using WB-DW-MRI. The results were consistent in seven patients and in three cases, a lesion was observed using WB-DW-MRI that was not detected with choline-PET/CT. The Kappa value obtained was 0.133 (p = 0.089); the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WB-DW-MRI were estimated at 44.93, 64.29, 86.11, and 19.15%, respectively. For choline-PET/CT patients, the sensitivity, specificity, PPV, and NPV were 97.10, 58.33, 93.06, and 77.78%, respectively.
  
  
  CONCLUSIONS
  Choline-PET/CT has a high global sensitivity while WB-DW-MRI has a high specificity, and so they are complementary techniques. Future studies with more enrolled patients and a longer follow-up period will be required to confirm these data. The initial data show that the best technique for evaluating response after SBRT is choline-PET/CT. Trial registration number NCT02858128.
authors: Radiation Oncology Department, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain. antoniojconde@gmail.com.
authors: A J
authors: http://orcid.org/0000-0003-1024-0924
authors: AJ
authors: Conde-Moreno
authors: Radiation Oncology Department, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
authors: G
authors: G
authors: Herrando-Parreño
authors: Radiation Oncology Department, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
authors: R
authors: R
authors: Muelas-Soria
authors: Nuclear Medicine Department, Eresa Hospital General de Valencia, Valencia, Spain.
authors: J
authors: J
authors: Ferrer-Rebolleda
authors: MRI Department, Eresa-Hospital General de Castellón, Valencia, Spain.
authors: R
authors: R
authors: Broseta-Torres
authors: Nuclear Medicine Department, Eresa Hospital General de Valencia, Valencia, Spain.
authors: M P
authors: MP
authors: Cozar-Santiago
authors: Biostatistics Department, Fundación Hospital Provincial de Castellón, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
authors: F
authors: F
authors: García-Piñón
authors: Radiation Oncology Department, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
authors: C
authors: C
authors: Ferrer-Albiach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002794:Choline; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity
chemical_list: D002794:Choline
keywords: Choline-PET/CT; Oligometastases; Prostate cancer; WB-DW-MRI