Histological verification of 11C-choline-positron emission/computed tomography-positive lymph nodes in patients with biochemical failure after treatment for localized prostate cancer

BJU Int. 2008 Aug;102(4):446-51. doi: 10.1111/j.1464-410X.2008.07592.x. Epub 2008 Apr 11.

Abstract

Objectives: To evaluate the potential of (11)C-choline-positron emission tomography (PET)/computed tomography (CT) for planning surgery in patients with prostate cancer and prostate-specific antigen (PSA) relapse after treatment with curative intent.

Patients and methods: We retrospectively reviewed the charts of 10 patients with PSA recurrence after either external beam radiation (two) or radical retropubic prostatectomy (eight) for prostate cancer, and who had a laparoscopic lymphadenectomy for suspicious lymph nodes detected on (11)C-choline-PET/CT. The histological results and PET/CT findings were compared.

Results: In all, 22 suspicious lymph nodes were found on PET/CT, and 14 on conventional CT or magnetic resonance imaging. Comparing the conventional imaging showed concordance in 13 lymph nodes. Three of the 10 patients had no metastatic lymph node disease on definitive histology. The mean (SD) PSA level for these patients was 1.0 (0.4) ng/mL, whereas that in patients with lymph node metastases was 15.1 (9.2) ng/mL (statistically significant difference, P < 0.05). The positive predictive value was seven of 10. All of the patients initially regressed, with PSA increases after lymphadenectomy. Two of the patients are being managed by watchful waiting, two had radiotherapy of the prostate fossa and two had chemotherapy with docetaxel. Four patients were treated by hormone-deprivation therapy. After a mean (SD) follow up of 11 (7) months, one patient died, one has PSA progression, but none of those with negative histology has clinical signs of local recurrence.

Conclusions: (11)C-choline-PET is a valuable tool for detecting recurrent prostate cancer, but the limited positive predictive value should lead to a critical interpretation of the results.

Publication types

  • Evaluation Study

MeSH terms

  • Analysis of Variance
  • Carbon Radioisotopes / therapeutic use
  • Choline*
  • Humans
  • Length of Stay
  • Lymph Node Excision
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology*
  • Lymph Nodes / surgery
  • Male
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm Staging
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Prostate-Specific Antigen / blood
  • Prostatectomy
  • Prostatic Neoplasms / diagnostic imaging
  • Prostatic Neoplasms / pathology*
  • Prostatic Neoplasms / therapy
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Salvage Therapy / methods
  • Sensitivity and Specificity

Substances

  • Carbon Radioisotopes
  • Radiopharmaceuticals
  • Prostate-Specific Antigen
  • Choline