title: 11C-acetate positron-emission tomography/computed tomography imaging for detection of recurrent disease after radical prostatectomy or radiotherapy in patients with prostate cancer.
abstract: To evaluate, in a prospective study, the effectiveness of computed tomography (CT)-matched 11C-acetate (AC) positron-emission tomography (PET) in patients with prostate cancer (PCa) who had prostate-specific antigen (PSA) relapse after radical prostatectomy (RP) or radiotherapy (RT).
  
  
  
  In 103 relapsing patients after RP (n = 97) or RT (n = 6) AC-PET images and CT scans were obtained. In patients with AC-PET-positive results with localized PCa recurrence, detected lesions were resected and histologically verified or, after local RT, followed-up by PSA testing. Patients with distant disease on AC-PET were treated with androgen deprivation/chemotherapy.
  
  
  
  Of 103 patients, 42 were AC-PET-positive. PSA levels were <1.0, <2.0 and <4.0 ng/mL in six, 16 and 20 patients, respectively. In 25/42 patients AC-PET suggested lymph node metastases: 16/25 patients underwent surgery (10/16 metastasis, 6/16 inflammation); 9/25 patients underwent RT of lymph node metastases, which was followed by decreasing PSA level. In 17/42 patients who had distant disease, systemic treatment was commenced. Combining patients who underwent surgery and those who underwent RT, 19/25 patients were true-positive in terms of AC-PET (positive predictive value 76%). In 5/19 patients, PSA level was <2.0 ng/mL, in 2/19 patients it was <1.0 ng/mL and in 14/19 patients it was 5.4-23.1 ng/mL. In AC-PET-positive patients after surgery or RT (without androgen deprivation), median (range) time to renewed PSA increase was 6 (5-9) months.
  
  
  
  Only a minority of patients with relapsing PCa appear to benefit from AC-PET for guiding potential local treatment. False-positive results show that factors other than tumour metabolism induce increased AC uptake. The time free of recurrence after local treatment was shorter than expected.
authors.affiliation: Department of Urology, St Antonius Hospital, Gronau, Germany.
authors.forename: Lukas Hendrik
authors.identifier: 0000-0003-1473-004X
authors.initials: LH
authors.lastname: Esch
authors.affiliation: Department of Gynaecology, Bethesda Hospital, Duisburg, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Fahlbusch
authors.affiliation: Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.affiliation: Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Hautzel
authors.affiliation: Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Müller-Mattheis
mesh_terms: D000085:Acetates / Q000627:therapeutic use; D000368:Aged; D002250:Carbon Radioisotopes / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy*
chemical_list: D000085:Acetates; D002250:Carbon Radioisotopes; D017430:Prostate-Specific Antigen
keywords: #PCSM; #ProstateCancer; 11C-acetate; PET; PET/CT; relapse