18F-Choline Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging for the Detection of Early Local Recurrence of Prostate Cancer Initially Treated by Radiation Therapy: Comparison With Systematic 3-Dimensional Transperineal Mapping Biopsy.
To compare the diagnostic performance of18F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT), multiparametric prostate magnetic resonance imaging (mpMRI), and a combination of both techniques for the detection of local recurrence of prostate cancer initially treated by radiation therapy.



This was a retrospective, single-institution study of 32 patients with suspected prostate cancer recurrence who underwent both FCH-PET/CT and 3T mpMRI within 3 months of one another for the detection of recurrence. All included patients had to be cleared for metastatic recurrence. The reference procedure was systematic 3-dimensional (3D)-transperineal prostate biopsy for the final assessment of local recurrence. Both imaging modalities were analyzed by 2 experienced readers blinded to clinical data. The analysis was made per-patient and per-segment using a 4-segment model.



The median prostate-specific antigen value at the time of imaging was 2.92 ng/mL. The mean prostate-specific antigen doubling time was 14 months. Of the 32 patients, 31 had a positive 3D-transperineal mapping biopsy for a local relapse. On a patient-based analysis, the detection rate was 71% (22 of 31) for mpMRI and 74% (23 of 31) for FCH-PET/CT. On a segment-based analysis, the sensitivity and specificity were, respectively, 32% and 87% for mpMRI, 34% and 87% for FCH-PET/CT, and 43% and 83% for the combined analysis of both techniques. Accuracy was 64%, 65%, and 66%, respectively. The interobserver agreement was κ = 0.92 for FCH-PET/CT and κ = 0.74 for mpMRI.



Both mpMRI and FCH-PET/CT show limited sensitivity but good specificity for the detection of local cancer recurrence after radiation therapy, when compared with 3D-transperineal mapping biopsy. Prostate biopsy still seems to be mandatory to diagnose local relapse and select patients who could benefit from local salvage therapy.
Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France; LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon, France; MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France. Electronic address: Salim.kanoun@gmail.com.
Salim
S
Kanoun
LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon, France; MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
Paul
P
Walker
Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.
Jean-Marc
JM
Vrigneaud
Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.
Edouard
E
Depardon
Department of Urology, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
Vincent
V
Barbier
Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.
Olivier
O
Humbert
Department of Urology, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
Morgan
M
Moulin
LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon, France; Department of Radiation Oncology, Centre Georges-François Leclerc, Dijon, France.
Gilles
G
Créhange
Department of Urology, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
Luc
L
Cormier
LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon, France; Department of Vascular, Oncologic and Interventional Radiology, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
Romaric
R
Loffroy
Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France; LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon, France; MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
François
F
Brunotte
Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France; LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon, France; MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
Alexandre
A
Cochet
D000368:Aged; D001706:Biopsy / Q000379:methods; D002794:Choline / Q000031:analogs & derivatives; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000517:prevention & control; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D019275:Radiopharmaceuticals; C516370:fluoromethylcholine; D002794:Choline