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FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade prostate cancer at biopsy.

Beauregard JM, Blouin AC, Fradet V, Caron A, Fradet Y, Lemay C, Lacombe L, Dujardin T, Tiguert R, Rimac G, Bouchard F, Pouliot F - Cancer Imaging (2015)

Bottom Line: Patients without IPFU who underwent RP were downgraded to Gleason≤7 in 84.6% of cases, as compared to 30.8% when IPFU was reported (P=0.003).Qualitative and quantitative IPFU were significantly positively correlated with post-RP Gleason pattern and sum, and pathological T stage.Absence and presence of IPFU were associated with a median 5-year cancer-free survival probability of 70.2 and 26.9% (P=0.0097), respectively, using the CAPRA-S prognostic tool.

View Article: PubMed Central - PubMed

Affiliation: Division of Nuclear Medicine, Department of Radiology and Cancer Research Center, Université Laval, Quebec City, Canada. jean-mathieu.beauregard@chuq.qc.ca.

ABSTRACT

Background: The role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in prostate cancer (PCa) has not been well defined yet. Because high-grade PCa tends to exhibit increased glycolytic rate, FDG-PET/CT could be useful in this setting. The aim of this study was to assess the value of FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade PCa at biopsy.

Methods: Fifty-four patients with a Gleason sum≥8 PCa at biopsy underwent FDG-PET/CT as part of the staging workup. Thirty-nine patients underwent radical prostatectomy (RP) and pelvic lymph node (LN) dissection, 2 underwent LN dissection only, and 13 underwent non-surgical treatments. FDG-PET/CT findings from clinical reports, blinded reading and quantitative analysis were correlated with clinico-pathological characteristics at RP.

Results: Suspicious foci of increased FDG uptake were found in the prostate, LNs and bones in 44, 13 and 6% of patients, respectively. Higher clinical stage, post-RP Gleason sum and pattern, and percentage of cancer involvement within the prostate were significantly associated with the presence of intraprostatic FDG uptake (IPFU) (P<0.05 in all cases). Patients without IPFU who underwent RP were downgraded to Gleason≤7 in 84.6% of cases, as compared to 30.8% when IPFU was reported (P=0.003). Qualitative and quantitative IPFU were significantly positively correlated with post-RP Gleason pattern and sum, and pathological T stage. Absence and presence of IPFU were associated with a median 5-year cancer-free survival probability of 70.2 and 26.9% (P=0.0097), respectively, using the CAPRA-S prognostic tool.

Conclusion: These results suggest that, among patients with a high-grade PCa at biopsy, FDG-PET/CT could improve pre-treatment prognostic stratification by predicting primary PCa pathological grade and survival probability following RP.

No MeSH data available.


Related in: MedlinePlus

Fused FDG-PET/CT transaxial slices in a patient with a Gleason sum 9 (4 + 5) PCa at biopsy showing (A) a highly hypermetabolic prostatic focus (positive clinical report; score = 3; SUVmax = 7.1) and (C) one of two bone metastases, which were intensely hypermetabolic and lytic on CT (E). Three months after ADT initiation, there was a complete metabolic response of the primary PCa lesion (B). The bone lesions underwent at least a partial metabolic response (D) and became sclerotic on CT (F). Possibly, the osteoblasts repair activity contributed to the residual FDG uptake. The metabolic response was consistent with the biochemical response, with the PSA decreasing from 125 to 1.5 ng/L.
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Fig3: Fused FDG-PET/CT transaxial slices in a patient with a Gleason sum 9 (4 + 5) PCa at biopsy showing (A) a highly hypermetabolic prostatic focus (positive clinical report; score = 3; SUVmax = 7.1) and (C) one of two bone metastases, which were intensely hypermetabolic and lytic on CT (E). Three months after ADT initiation, there was a complete metabolic response of the primary PCa lesion (B). The bone lesions underwent at least a partial metabolic response (D) and became sclerotic on CT (F). Possibly, the osteoblasts repair activity contributed to the residual FDG uptake. The metabolic response was consistent with the biochemical response, with the PSA decreasing from 125 to 1.5 ng/L.

Mentions: FDG-PET/CT results from clinical reports, blinded qualitative reading and quantitative analysis are presented on a per-patient basis in Table 3 and examples are depicted in Figure 2. The three patients with bone disease had their bone metastases detected by both FDG-PET/CT and bone scan (Figure 3). Of 7 patients with suspected LN metastasis on FDG-PET/CT, 3 had pathological confirmation at surgery and 4 had metabolic response after 3 months of ADT, consistent with a specificity of 100%. FDG-PET/CT detected LN metastases in 3/11 (27%) patients with pathology-proven LN disease at surgery.Table 3


FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade prostate cancer at biopsy.

Beauregard JM, Blouin AC, Fradet V, Caron A, Fradet Y, Lemay C, Lacombe L, Dujardin T, Tiguert R, Rimac G, Bouchard F, Pouliot F - Cancer Imaging (2015)

Fused FDG-PET/CT transaxial slices in a patient with a Gleason sum 9 (4 + 5) PCa at biopsy showing (A) a highly hypermetabolic prostatic focus (positive clinical report; score = 3; SUVmax = 7.1) and (C) one of two bone metastases, which were intensely hypermetabolic and lytic on CT (E). Three months after ADT initiation, there was a complete metabolic response of the primary PCa lesion (B). The bone lesions underwent at least a partial metabolic response (D) and became sclerotic on CT (F). Possibly, the osteoblasts repair activity contributed to the residual FDG uptake. The metabolic response was consistent with the biochemical response, with the PSA decreasing from 125 to 1.5 ng/L.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352558&req=5

Fig3: Fused FDG-PET/CT transaxial slices in a patient with a Gleason sum 9 (4 + 5) PCa at biopsy showing (A) a highly hypermetabolic prostatic focus (positive clinical report; score = 3; SUVmax = 7.1) and (C) one of two bone metastases, which were intensely hypermetabolic and lytic on CT (E). Three months after ADT initiation, there was a complete metabolic response of the primary PCa lesion (B). The bone lesions underwent at least a partial metabolic response (D) and became sclerotic on CT (F). Possibly, the osteoblasts repair activity contributed to the residual FDG uptake. The metabolic response was consistent with the biochemical response, with the PSA decreasing from 125 to 1.5 ng/L.
Mentions: FDG-PET/CT results from clinical reports, blinded qualitative reading and quantitative analysis are presented on a per-patient basis in Table 3 and examples are depicted in Figure 2. The three patients with bone disease had their bone metastases detected by both FDG-PET/CT and bone scan (Figure 3). Of 7 patients with suspected LN metastasis on FDG-PET/CT, 3 had pathological confirmation at surgery and 4 had metabolic response after 3 months of ADT, consistent with a specificity of 100%. FDG-PET/CT detected LN metastases in 3/11 (27%) patients with pathology-proven LN disease at surgery.Table 3

Bottom Line: Patients without IPFU who underwent RP were downgraded to Gleason≤7 in 84.6% of cases, as compared to 30.8% when IPFU was reported (P=0.003).Qualitative and quantitative IPFU were significantly positively correlated with post-RP Gleason pattern and sum, and pathological T stage.Absence and presence of IPFU were associated with a median 5-year cancer-free survival probability of 70.2 and 26.9% (P=0.0097), respectively, using the CAPRA-S prognostic tool.

View Article: PubMed Central - PubMed

Affiliation: Division of Nuclear Medicine, Department of Radiology and Cancer Research Center, Université Laval, Quebec City, Canada. jean-mathieu.beauregard@chuq.qc.ca.

ABSTRACT

Background: The role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in prostate cancer (PCa) has not been well defined yet. Because high-grade PCa tends to exhibit increased glycolytic rate, FDG-PET/CT could be useful in this setting. The aim of this study was to assess the value of FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade PCa at biopsy.

Methods: Fifty-four patients with a Gleason sum≥8 PCa at biopsy underwent FDG-PET/CT as part of the staging workup. Thirty-nine patients underwent radical prostatectomy (RP) and pelvic lymph node (LN) dissection, 2 underwent LN dissection only, and 13 underwent non-surgical treatments. FDG-PET/CT findings from clinical reports, blinded reading and quantitative analysis were correlated with clinico-pathological characteristics at RP.

Results: Suspicious foci of increased FDG uptake were found in the prostate, LNs and bones in 44, 13 and 6% of patients, respectively. Higher clinical stage, post-RP Gleason sum and pattern, and percentage of cancer involvement within the prostate were significantly associated with the presence of intraprostatic FDG uptake (IPFU) (P<0.05 in all cases). Patients without IPFU who underwent RP were downgraded to Gleason≤7 in 84.6% of cases, as compared to 30.8% when IPFU was reported (P=0.003). Qualitative and quantitative IPFU were significantly positively correlated with post-RP Gleason pattern and sum, and pathological T stage. Absence and presence of IPFU were associated with a median 5-year cancer-free survival probability of 70.2 and 26.9% (P=0.0097), respectively, using the CAPRA-S prognostic tool.

Conclusion: These results suggest that, among patients with a high-grade PCa at biopsy, FDG-PET/CT could improve pre-treatment prognostic stratification by predicting primary PCa pathological grade and survival probability following RP.

No MeSH data available.


Related in: MedlinePlus