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Predictive factors of [11C]choline PET/CT in patients with biochemical failure after radical prostatectomy

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Abstract

Purpose

Detection of recurrence in prostate cancer patients with biochemical failure after radical prostatectomy by [11C]choline PET/CT depends on the prostate-specific antigen (PSA) level. The role of other clinical and pathological variables has not been explored.

Methods

A total of 2,124 prostate cancer patients referred to our Institution for [11C]choline PET/CT from December 2004 to January 2007 for restaging of disease were retrospectively considered for this study. Inclusion criteria were: previous treatment by radical prostatectomy, and biochemical failure, defined as at least two consecutive PSA measurements of >0.2 ng/ml. These criteria were met for 358 patients. Binary logistic analysis was used to investigate the predictive factors of [11C]choline PET/CT. PET/CT findings were validated using criteria based on histological analysis, and follow-up clinical and imaging data. Receiver operating characteristic (ROC) analysis was used to assess the performance of [11C]choline PET/CT in relation to PSA levels.

Results

The mean PSA level was 3.77 ± 6.94 ng/ml (range 0.23–45 ng/ml; median 1.27 ng/ml). PET/CT was positive for recurrence in 161 of 358 patients (45%). On an anatomical region basis, [11C]choline pathological uptake was observed in lymph nodes (107/161 patients, 66%), prostatectomy bed (55/161 patients, 34%), and in the skeleton (46/161 patients, 29%). PET/CT findings were validated using histological criteria (46/358, 13%), and follow-up clinical and imaging criteria (312/358, 87%). Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were, respectively, 85%, 93%, 91%, 87%, and 89%. In multivariate analysis, high PSA levels, advanced pathological stage, previous biochemical failure and older age were significantly (P < 0.05) associated with an increased risk of positive PET/CT findings. The percentage of positive scans was 19% in those with a PSA level between 0.2 and 1 ng/ml, 46% in those with a PSA level between 1 and 3 ng/ml, and 82% in those with a PSA level higher than 3 ng/ml. ROC analysis showed that PET/CT-positive and PET/CT-negative patients could be best distinguished using a PSA cut-off value of 1.4 ng/ml.

Conclusions

In addition to PSA levels, pathological stage, previous biochemical failure and age should be considered by physicians when referring prostate cancer patients with biochemical failure after radical prostatectomy to [11C]choline PET/CT.

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Acknowledgments

The authors would like to acknowledge Elisabetta Vassenna for helping in data collection and all staff physicians of the Nuclear Medicine Department for contributing to the performance of the [11C]choline PET/CT scans.

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Authors and Affiliations

  1. Center for Molecular Bioimaging, University of Milano-Bicocca, Milano, Italy

    Giampiero Giovacchini, Elisa Coradeschi, Ferruccio Fazio & Cristina Messa

  2. Department of Nuclear Medicine, Scientific Institute San Raffaele, Milano, Italy

    Maria Picchio, Valentino Bettinardi, Luigi Gianolli & Ferruccio Fazio

  3. Department of Urology, Scientific Institute San Raffaele, Milano, Italy

    Vincenzo Scattoni & Patrizio Rigatti

  4. Department of Radiation Oncology, Scientific Institute San Raffaele, Milano, Italy

    Cesare Cozzarini, Nadia Di Muzio & Ferruccio Fazio

  5. Institute for Bioimaging and Molecular Physiology, National Research Council, Milano, Italy

    Cristina Messa

  6. Department of Nuclear Medicine, Hospital San Gerardo, Via Pergolesi, 33, 20052, Monza, Italy

    Cristina Messa

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  1. Giampiero Giovacchini
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Correspondence to Cristina Messa.

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Giovacchini, G., Picchio, M., Coradeschi, E. et al. Predictive factors of [11C]choline PET/CT in patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging 37, 301–309 (2010). https://doi.org/10.1007/s00259-009-1253-3

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  • DOI: https://doi.org/10.1007/s00259-009-1253-3

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