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Detection of recurrent prostate cancer with 18F-fluorocholine PET/CT in relation to PSA level at the time of imaging.

Kwee SA, Coel MN, Lim J - Ann Nucl Med (2012)

Bottom Line: PET detection rates were determined at various PSA thresholds and examined by receiver operating characteristic analysis.These findings were indicative of local/regional recurrence in 23 cases and systemic recurrence in 8 cases, with only a single route of recurrence (i.e., either hematogenous, lymphatic, or intraprostatic) in 84% of PET scans with positive findings.Abnormal tumor activity was detected in 88% of patients with a PSA level of 1.1 ng/mL or higher, and in only 6% of patients with a PSA level below this threshold value.

View Article: PubMed Central - PubMed

Affiliation: Hamamatsu/Queen's PET Imaging Center, The Queen's Medical Center, Honolulu, HI 96813, USA. skwee@queens.org

ABSTRACT

Purpose: To evaluate fluorine-18 fluorocholine (FCH) PET/CT for the detection of recurrent prostate cancer in relation to prostate-specific antigen (PSA) level.

Methods: FCH PET/CT was performed in 50 patients with rising PSA levels at follow-up of primary treatment of prostate cancer (radical prostatectomy in 28, radiation therapy in 13, and brachytherapy in 9). PET detection rates were determined at various PSA thresholds and examined by receiver operating characteristic analysis.

Results: Findings consistent with recurrent prostate cancer were noted on FCH PET/CT in 31/50 (62%) patients, with positive findings in 17/18 (94%), and 11/13 (85%), 2/7 (29%), and 1/12 (8%) patients with PSA >4, >2-4, >0.5-2, and ≤0.5 ng/mL, respectively. These findings were indicative of local/regional recurrence in 23 cases and systemic recurrence in 8 cases, with only a single route of recurrence (i.e., either hematogenous, lymphatic, or intraprostatic) in 84% of PET scans with positive findings. Abnormal tumor activity was detected in 88% of patients with a PSA level of 1.1 ng/mL or higher, and in only 6% of patients with a PSA level below this threshold value.

Conclusion: FCH PET/CT may serve to identify the route of tumor progression in patients with recurrent prostate cancer; however, the likelihood of tumor detection may be related to the PSA level at the time of imaging.

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Isolated retroperitoneal lymph node detected at a PSA of 0.3 ng/mL. a An 11-mm diameter retroperitoneal lymph node (arrowhead) with maximum SUV of 2.7 was the only abnormality found on FCH PET/CT in this patient with PSA of 0.3 ng/mL. This finding corresponds to the lowest PSA value associated with a positive FCH PET/CT result in this study. Note that the left ureter (thin arrow) is laterally adjacent to this lymph node. Because FCH is excreted into the urine, careful anatomical correspondence with CT images is necessary to avoid a misinterpretation due to urinary artifacts. Gentle fluid restriction was also used in this patient to reduce the amount of ureteral activity at the time of PET scanning. b At follow-up, this lymph node was found to be enlarged, measuring 13 mm on diagnostic CT performed with oral and intravenous contrast after the PSA level had risen to 1.0 ng/mL in 1 month. Additional lymph nodes measuring up to 6 mm (not shown) were also found along the left retroperitoneum at follow-up
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Fig3: Isolated retroperitoneal lymph node detected at a PSA of 0.3 ng/mL. a An 11-mm diameter retroperitoneal lymph node (arrowhead) with maximum SUV of 2.7 was the only abnormality found on FCH PET/CT in this patient with PSA of 0.3 ng/mL. This finding corresponds to the lowest PSA value associated with a positive FCH PET/CT result in this study. Note that the left ureter (thin arrow) is laterally adjacent to this lymph node. Because FCH is excreted into the urine, careful anatomical correspondence with CT images is necessary to avoid a misinterpretation due to urinary artifacts. Gentle fluid restriction was also used in this patient to reduce the amount of ureteral activity at the time of PET scanning. b At follow-up, this lymph node was found to be enlarged, measuring 13 mm on diagnostic CT performed with oral and intravenous contrast after the PSA level had risen to 1.0 ng/mL in 1 month. Additional lymph nodes measuring up to 6 mm (not shown) were also found along the left retroperitoneum at follow-up

Mentions: The optimal PSA threshold for discriminating FCH PET/CT scans with positive findings was determined by receiver operating characteristic analysis to be 1.1 ng/mL. Based on this threshold, 88 % (30/34) of the patients with a PSA ≥1.1 ng/mL had positive PET/CT results (Fig. 2). The only FCH PET/CT that was positive below this threshold corresponded to a patient with PSA level of 0.3 ng/mL in whom a single retroperitoneal lymph node was detected on the basis of increased FCH uptake on PET/CT (Fig. 3). Thus, diagnostic sensitivity of FCH PET/CT on a per patient basis in this study was 88 % in patients with a PSA level of 1.1 ng/mL or higher.Fig. 2


Detection of recurrent prostate cancer with 18F-fluorocholine PET/CT in relation to PSA level at the time of imaging.

Kwee SA, Coel MN, Lim J - Ann Nucl Med (2012)

Isolated retroperitoneal lymph node detected at a PSA of 0.3 ng/mL. a An 11-mm diameter retroperitoneal lymph node (arrowhead) with maximum SUV of 2.7 was the only abnormality found on FCH PET/CT in this patient with PSA of 0.3 ng/mL. This finding corresponds to the lowest PSA value associated with a positive FCH PET/CT result in this study. Note that the left ureter (thin arrow) is laterally adjacent to this lymph node. Because FCH is excreted into the urine, careful anatomical correspondence with CT images is necessary to avoid a misinterpretation due to urinary artifacts. Gentle fluid restriction was also used in this patient to reduce the amount of ureteral activity at the time of PET scanning. b At follow-up, this lymph node was found to be enlarged, measuring 13 mm on diagnostic CT performed with oral and intravenous contrast after the PSA level had risen to 1.0 ng/mL in 1 month. Additional lymph nodes measuring up to 6 mm (not shown) were also found along the left retroperitoneum at follow-up
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Related In: Results  -  Collection

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Fig3: Isolated retroperitoneal lymph node detected at a PSA of 0.3 ng/mL. a An 11-mm diameter retroperitoneal lymph node (arrowhead) with maximum SUV of 2.7 was the only abnormality found on FCH PET/CT in this patient with PSA of 0.3 ng/mL. This finding corresponds to the lowest PSA value associated with a positive FCH PET/CT result in this study. Note that the left ureter (thin arrow) is laterally adjacent to this lymph node. Because FCH is excreted into the urine, careful anatomical correspondence with CT images is necessary to avoid a misinterpretation due to urinary artifacts. Gentle fluid restriction was also used in this patient to reduce the amount of ureteral activity at the time of PET scanning. b At follow-up, this lymph node was found to be enlarged, measuring 13 mm on diagnostic CT performed with oral and intravenous contrast after the PSA level had risen to 1.0 ng/mL in 1 month. Additional lymph nodes measuring up to 6 mm (not shown) were also found along the left retroperitoneum at follow-up
Mentions: The optimal PSA threshold for discriminating FCH PET/CT scans with positive findings was determined by receiver operating characteristic analysis to be 1.1 ng/mL. Based on this threshold, 88 % (30/34) of the patients with a PSA ≥1.1 ng/mL had positive PET/CT results (Fig. 2). The only FCH PET/CT that was positive below this threshold corresponded to a patient with PSA level of 0.3 ng/mL in whom a single retroperitoneal lymph node was detected on the basis of increased FCH uptake on PET/CT (Fig. 3). Thus, diagnostic sensitivity of FCH PET/CT on a per patient basis in this study was 88 % in patients with a PSA level of 1.1 ng/mL or higher.Fig. 2

Bottom Line: PET detection rates were determined at various PSA thresholds and examined by receiver operating characteristic analysis.These findings were indicative of local/regional recurrence in 23 cases and systemic recurrence in 8 cases, with only a single route of recurrence (i.e., either hematogenous, lymphatic, or intraprostatic) in 84% of PET scans with positive findings.Abnormal tumor activity was detected in 88% of patients with a PSA level of 1.1 ng/mL or higher, and in only 6% of patients with a PSA level below this threshold value.

View Article: PubMed Central - PubMed

Affiliation: Hamamatsu/Queen's PET Imaging Center, The Queen's Medical Center, Honolulu, HI 96813, USA. skwee@queens.org

ABSTRACT

Purpose: To evaluate fluorine-18 fluorocholine (FCH) PET/CT for the detection of recurrent prostate cancer in relation to prostate-specific antigen (PSA) level.

Methods: FCH PET/CT was performed in 50 patients with rising PSA levels at follow-up of primary treatment of prostate cancer (radical prostatectomy in 28, radiation therapy in 13, and brachytherapy in 9). PET detection rates were determined at various PSA thresholds and examined by receiver operating characteristic analysis.

Results: Findings consistent with recurrent prostate cancer were noted on FCH PET/CT in 31/50 (62%) patients, with positive findings in 17/18 (94%), and 11/13 (85%), 2/7 (29%), and 1/12 (8%) patients with PSA >4, >2-4, >0.5-2, and ≤0.5 ng/mL, respectively. These findings were indicative of local/regional recurrence in 23 cases and systemic recurrence in 8 cases, with only a single route of recurrence (i.e., either hematogenous, lymphatic, or intraprostatic) in 84% of PET scans with positive findings. Abnormal tumor activity was detected in 88% of patients with a PSA level of 1.1 ng/mL or higher, and in only 6% of patients with a PSA level below this threshold value.

Conclusion: FCH PET/CT may serve to identify the route of tumor progression in patients with recurrent prostate cancer; however, the likelihood of tumor detection may be related to the PSA level at the time of imaging.

Show MeSH
Related in: MedlinePlus