1
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Latorzeff I, Ploussard G, Schick U, Benziane N, Pasquier D, Sargos P. [Salvage radiotherapy after prostatectomy - what do do in case of elevated post operative PSA or macroscopic relapse?]. Cancer Radiother 2021; 25:822-829. [PMID: 34702645 DOI: 10.1016/j.canrad.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
The management of the postoperative biological relapse of prostate cancer is most often based on salvage radiotherapy (RT) and a variable duration of hormone therapy (HT) in addition. The indications for RT±HT become more consensual for the adjuvant postoperative situation or in the event of a rising PSA level after a period where an undetectable PSA level was achieved. On the other hand, in the event of detectable PSA immediately postoperatively or in the event of a biological recurrence with macroscopic relapse in the prostate bed seen on conventional imaging assessment, the treatment options are still being evaluated. This article will describe these 2 situations and their current management but also will come through assessments with the contribution of modern imaging and new treatment options in terms of RT dose and RT±HT combination.
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Affiliation(s)
- I Latorzeff
- Département de radiothérapie-oncologie, Bât Atrium, clinique Pasteur, 1, rue de la Petite-Vitesse, 31300 Toulouse, France.
| | - G Ploussard
- Département d'urologie, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - U Schick
- Département de radiothérapie-oncologie, CHU de Brest, Brest, France
| | - N Benziane
- Département de radiothérapie, institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux cedex, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre O.-Lambret, 3, rue F.-Combemale, 59020 Lille, France
| | - P Sargos
- Département de radiothérapie, institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux cedex, France
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2
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le Guevelou J, Achard V, Mainta I, Zaidi H, Garibotto V, Latorzeff I, Sargos P, Ménard C, Zilli T. PET/CT-Based Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy: Impact on Treatment Management and Future Directions. Front Oncol 2021; 11:742093. [PMID: 34532294 PMCID: PMC8438304 DOI: 10.3389/fonc.2021.742093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022] Open
Abstract
Biochemical recurrence is a clinical situation experienced by 20 to 40% of prostate cancer patients treated with radical prostatectomy (RP). Prostate bed (PB) radiation therapy (RT) remains the mainstay salvage treatment, although it remains non-curative for up to 30% of patients developing further recurrence. Positron emission tomography with computed tomography (PET/CT) using prostate cancer-targeting radiotracers has emerged in the last decade as a new-generation imaging technique characterized by a better restaging accuracy compared to conventional imaging. By adapting targeting of recurrence sites and modulating treatment management, implementation in clinical practice of restaging PET/CT is challenging the established therapeutic standards born from randomized controlled trials. This article reviews the potential impact of restaging PET/CT on changes in the management of recurrent prostate cancer after RP. Based on PET/CT findings, it addresses potential adaptation of RT target volumes and doses, as well as use of androgen-deprivation therapy (ADT). However, the impact of such management changes on the oncological outcomes of PET/CT-based salvage RT strategies is as yet unknown.
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Affiliation(s)
- Jennifer le Guevelou
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Division of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Vérane Achard
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Ismini Mainta
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland
| | - Habib Zaidi
- Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland.,Geneva Neuroscience Center, Geneva University, Geneva, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Valentina Garibotto
- Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, Geneva, Switzerland.,Geneva Neuroscience Center, Geneva University, Geneva, Switzerland
| | - Igor Latorzeff
- Department of Radiation Oncology, Groupe Oncorad-Garonne, Clinique Pasteur, Toulouse, France
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Cynthia Ménard
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Thomas Zilli
- Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
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3
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Schmidt Hegemann NS, Rogowski P, Eze C, Schäfer C, Stief C, Lang S, Spohn S, Steffens R, Li M, Gratzke C, Schultze-Seemann W, Ilhan H, Fendler WP, Bartenstein P, Ganswindt U, Buchner A, Grosu AL, Belka C, Meyer PT, Kirste S, Zamboglou C. Outcome After 68Ga-PSMA-11 versus Choline PET-Based Salvage Radiotherapy in Patients with Biochemical Recurrence of Prostate Cancer: A Matched-Pair Analysis. Cancers (Basel) 2020; 12:cancers12113395. [PMID: 33207785 PMCID: PMC7698293 DOI: 10.3390/cancers12113395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
The purpose of this analysis was primarily to analyze biochemical-recurrence free survival (BRFS) after positron emission tomography (PET)-guided salvage radiotherapy (sRT) in a large cohort, and to further compare BRFS after PSMA vs. choline PET/ computer tomography (CT)-based sRT. This retrospective analysis is based on 421 patients referred for PSMA or choline PET/CT after radical prostatectomy due to biochemically recurrent or persistent disease. BRFS (PSA: 0.2 ng/mL) was defined as the study endpoint. Cox regression analyses were performed to assess the impact of different clinical parameters on BRFS. Additionally, propensity score matching was performed to adjust patient cohorts (PSMA vs. choline PET/CT-based sRT). The median follow-up time was 30 months. BRFS at three years after sRT was 58%. In the multivariate analysis, only PSA before PET imaging and PSA before sRT were significantly associated with BRFS (p < 0.05). After propensity score matching, 272 patients were further analyzed; there was no significant difference in three-year BRFS between patients with PSMA PET-based vs. choline PET-based sRT (55% vs. 63%, p = 0.197). The present analysis confirmed the overall high BRFS rates after PET-based sRT and the strong prognostic effect of PSA level prior to sRT. PSMA PET-based sRT did not have superior BRFS rates when compared with choline PET-based sRT.
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Affiliation(s)
- Nina-Sophie Schmidt Hegemann
- Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
| | - Christian Schäfer
- Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
| | - Christian Stief
- Department of Urology, University Hospital, 81377 LMU Munich, Germany; (C.S.); (A.B.)
| | - Sebastian Lang
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.)
| | - Simon Spohn
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.)
| | - Rieke Steffens
- Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
| | - Christian Gratzke
- Department of Urology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.G.); (W.S.-S.)
| | - Wolfgang Schultze-Seemann
- Department of Urology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.G.); (W.S.-S.)
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, 81377 LMU Munich, Germany; (H.I.); (P.B.)
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen, 47057 Essen, Germany;
- German Cancer Consortium (DKTK), University Hospital Essen, 45147 Essen, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, 81377 LMU Munich, Germany; (H.I.); (P.B.)
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, 6020 Innsbruck, Austria;
| | - Alexander Buchner
- Department of Urology, University Hospital, 81377 LMU Munich, Germany; (C.S.); (A.B.)
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.)
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
- German Cancer Consortium (DKTK), Partner Site Munich, 81377 Munich, Germany
| | - Philipp Tobias Meyer
- Department of Nuclear Medicine, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.)
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.)
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
- Bertha-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Correspondence: ; Tel.: +49-761-2709-4610; Fax: +49-761-2709-4720
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4
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D'Angelillo RM, Fiore M, Trodella LE, Sciuto R, Ippolito E, Carnevale A, Iurato A, Miele M, Trecca P, Trodella L, Greco C, Ramella S. 18F-choline PET/CT driven salvage radiotherapy in prostate cancer patients: up-date analysis with 5-year median follow-up. LA RADIOLOGIA MEDICA 2020; 125:668-673. [PMID: 32166718 DOI: 10.1007/s11547-020-01167-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Salvage radiotherapy is generally considered as the standard treatment for biochemical relapse after surgery. Best results have been obtained with a PSA value < 0.5 ng/ml at relapse, while 60-66 Gy is deemed as standard total dose. Modern imaging, as dynamic-18F-choline PET/CT may identify site of recurrence, allowing dose escalation to a biological target volume. METHODS Hundred and fifty patients showed a local relapse at dynamic-18F-choline PET/CT at time of biochemical recurrence. High-dose salvage radiotherapy was delivered up to total dose of 80 Gy to 18F-choline PET/CT positive area. Toxicity and relapse-free survival were recorded. RESULTS Median PSA value at the beginning of salvage radiotherapy was 0.47 ng/ml (range 0.2-17.5 ng/ml). One-hundred and thirty nine patients (93%) completed salvage radiotherapy without interruptions. Acute gastrointestinal grade ≥ 2 toxicity was recorded in 13 patients (9%), acute genitourinary grade ≥ 2 toxicity in 2 patients (1.4%). One patient (0.7%) experienced late gastrointestinal grade 4 toxicity and 2 patients (1.4%) late acute genitourinary grade 3 toxicity. With a median follow-up of 63.5 months, 5 and 7-years relapse-free survival were 70% and 60.7%, respectively. CONCLUSION With a median follow-up of 5 years the present study confirms that high-dose salvage radiotherapy to a biological target volume is feasible, with low rate of late toxicity and promising activity.
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Affiliation(s)
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Luca Eolo Trodella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy.
| | - Rosa Sciuto
- Department of Nuclear Medicin, Regina Elena National Cancer Institute, Rome, Italy
| | - Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Alessia Carnevale
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Aurelia Iurato
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Marianna Miele
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Pasquale Trecca
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Lucio Trodella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
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5
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Shelan M, Odermatt S, Bojaxhiu B, Nguyen DP, Thalmann GN, Aebersold DM, Dal Pra A. Disease Control With Delayed Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy. Front Oncol 2019; 9:12. [PMID: 30873377 PMCID: PMC6403145 DOI: 10.3389/fonc.2019.00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose: To retrospectively assess clinical outcomes and toxicity profile of prostate cancer patients treated with delayed dose-escalated image-guided salvage radiotherapy (SRT) for macroscopic local recurrence after radical prostatectomy (RP). Material and Methods: We report on a cohort of 69 consecutive patients with local recurrence after RP and no evidence of regional or distant metastasis who were referred for salvage radiotherapy between 2007 and 2016. SRT consisted of 64-66 Gy (2 Gy/fraction) to the prostatic bed followed by dose escalation to 72-74 Gy (2Gy/fraction) to the macroscopic disease. All patients received concurrent short-term androgen deprivation therapy (ADT). Biochemical recurrence-free survival (bRFS) and clinical progression-free-survival (cPFS) were depicted using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predictors of survival outcomes. Baseline, acute, and late urinary and gastrointestinal (GI) toxicity rates were reported using CTCAE v4.03. Results: Median time from RP to SRT was 66 months (IQR: 32-124). Median pre-SRT prostate-specific antigen (PSA) was 2.7 ng/ml (IQR: 0.9-6.5). Median follow-up after SRT was 38 months (IQR: 24-66). The 3- and 5-year bRFS were 58 and 44%, respectively. The 3- and 5-year cPFS were 91 and 76%, respectively. Median time from SRT to clinical disease progression was 102 months (IQR 77.5-165). At baseline, 3 patients (4%) had grade 3 urinary symptoms. Six patients (9%) developed acute and six patients (9%) developed late grade 3 urinary toxicity. Five patients (7%) had acute grade 2 GI toxicity. No acute grade 3 GI toxicity was reported. Late grade 3 GI toxicity was reported in one patient (1.5%). Conclusions: Delayed dose-escalated SRT combined with short-course ADT for macroscopic LR after RP was associated with 44% bRFS and 76% cPFS at 5 years. Albeit improved patient stratification is warranted, these data suggest that delayed SRT provides inferior tumor control compared to early intervention.
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Affiliation(s)
- Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Seline Odermatt
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel P. Nguyen
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George N. Thalmann
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
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6
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Schmidt-Hegemann NS, Stief C, Kim TH, Eze C, Kirste S, Strouthos I, Li M, Schultze-Seemann W, Ilhan H, Fendler WP, Bartenstein P, Grosu AL, Ganswindt U, Belka C, Meyer PT, Zamboglou C. Outcome after PSMA PET/CT based salvage radiotherapy in patients with biochemical recurrence after radical prostatectomy: a bi-institutional retrospective analysis. J Nucl Med 2018; 60:227-233. [PMID: 30002108 DOI: 10.2967/jnumed.118.212563] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/23/2018] [Indexed: 01/22/2023] Open
Abstract
Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) detects prostate cancer recurrence at low PSA levels. Radiotherapy with dose escalation to the former prostate bed has been associated with improved biochemical recurrence-free survival (BRFS). Thus, we hypothesized that PSMA PET/CT-guided salvage radiotherapy leads to improved BRFS. Methods: A total of 204 consecutive patients were referred for salvage radiotherapy following radical prostatectomy. PSMA PET/CT scans were performed and patients with PSA persistence (109 patients) or evidence of distant metastases (5 patients) were excluded from this analysis. Thus, the following analysis is based on a total of 90 patients who underwent PSMA PET/CT prior to radiotherapy due to biochemical recurrence and received salvage radiotherapy. In case of PET-positive findings, antiandrogen therapy was commenced before initiation of radiotherapy. BRFS (PSA ≤ 0.2 ng/ml) was defined as the study endpoint. Results: PET-positive lesions were detected in 42/90 (47%) patients: 24/42 (27%) fossa recurrence only, 12/42 (13%) pelvic lymph nodes only and 6/42 (7%) fossa and pelvic lymph node recurrence. Median PSA before radiotherapy was 0.44 (0.11 - 6.24). Cumulatively, a total dose of 70.0 Gy (67.2 - 72 Gy) was delivered to local macroscopic tumor, 66 Gy (59.4 - 70.2 Gy) to the prostatic fossa, 60.8 Gy (54 - 66 Gy) to PET-positive lymph nodes and 50.4 Gy (45 - 50.4 Gy) to the lymphatic pathways. After a median follow-up of 23 months, BRFS was 78%. Antiandrogen therapy was ongoing in 4 patients at last follow-up. No significant difference in BRFS between PET-positive (74%) vs. PET-negative patients (82%; p>0.05) was observed at last follow-up. Two patients had late genitourinary toxicity grade 3 and no patient had gastrointestinal toxicity ≥ 3 (NCI-CTCAE v4.03). Conclusion: PSMA PET/CT-guided salvage radiotherapy is an effective and safe local treatment option. No difference in BRFS between PET-positive and PET-negative patients was observed, indicating effective targeting of PET-positive lesions. PSMA PET/CT when readily available should be offered to patients with PSA recurrence for treatment individualization.
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Affiliation(s)
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Germany
| | - Tak-Hyun Kim
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Germany
| | - Iosif Strouthos
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | | | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Germany
| | | | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Germany
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Austria
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Germany
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7
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Gillebert Q, Huchet V, Rousseau C, Cochet A, Olivier P, Courbon F, Gontier E, Nataf V, Balogova S, Talbot JN. 18F-fluorocholine PET/CT in patients with occult biochemical recurrence of prostate cancer: Detection rate, impact on management and adequacy of impact. A prospective multicentre study. PLoS One 2018; 13:e0191487. [PMID: 29425221 PMCID: PMC5806856 DOI: 10.1371/journal.pone.0191487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/05/2018] [Indexed: 01/11/2023] Open
Abstract
Aim To prospectively evaluate the clinical impact and the diagnostic performance of FCH-PET/CT in patients with occult biochemical recurrence of prostate cancer (PCa). Materials and methods Results of 179 patients (mean PSA = 7.5ng/mL) with negative/inconclusive results of pelvic-MRI and of bone-scintigraphy were analysed. To determine the impact of FCH-PET/CT on diagnostic thinking and on patient management, the referring physicians prospectively filled-in a 1st and 2nd questionnaire related to patient’s planned management before and after FCH-PET/CT. Based on data from a 6-month follow-up after FCH-PET/CT, an independent assessor blinded to results of FCH-PET/CT determined the adequacy of management changes motivated by FCH-PET/CT. Results FCH-PET/CT localised foci evocative of recurrent PCa in 59% (105/179) of patients. Results of FCH-PET/CT motivated a change in scheduled patient management in 56% (100/179) of patients; which was considered as adequate in 89% (89/100) of patients. FCH-PET/CT also led to the detection of lung cancer in two patients. Conclusion FCH PET/CT is a powerful tool to localise the sites of occult biochemical recurrence of PCa, leading to an adequate management change in half of patients.
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Affiliation(s)
- Quentin Gillebert
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
| | - Virginie Huchet
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
| | | | - Alexandre Cochet
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
| | - Pierre Olivier
- Department of Nuclear Medicine, CHU Brabois, Vandoeuvre-lès-Nancy, France
| | - Frédéric Courbon
- Department of Nuclear Medicine, Institut Claudius Regaud, Toulouse, France
| | - Eric Gontier
- Department of Nuclear Medicine, HIA Val-de-Grâce, Paris, France
| | - Valérie Nataf
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
- Department of radiopharmacy, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sona Balogova
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
- Department of Nuclear Medicine, Comenius University & St Elisabeth Oncology Institute, Bratislava, Slovakia
- * E-mail:
| | - Jean-Noël Talbot
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
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8
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Lipman D, Pieters BR, De Reijke TM. Improving postoperative radiotherapy following radical prostatectomy. Expert Rev Anticancer Ther 2017; 17:925-937. [PMID: 28787182 DOI: 10.1080/14737140.2017.1364994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Prostate cancer has one of the highest incidences in the world, with good curative treatment options like radiotherapy and radical prostatectomy. Unfortunately, about 30% of the patients initially treated with curative intent will develop a recurrence and need adjuvant treatment. Five randomized trials covered the role of postoperative radiotherapy after radical prostatectomy, but there is still a lot of debate about which patients should receive postoperative radiotherapy. Areas covered: This review will give an overview on the available literature concerning post-operative radiotherapy following radical prostatectomy with an emphasis on the five randomized trials. Also, new imaging techniques like prostate-specific membrane antigen positron emission tomography (PSMA-PET) and multiparametric magnetic resonance imaging (mp-MRI) and the development of biomarkers like genomic classifiers will be discussed in the search for an improved selection of patients who will benefit from postoperative radiotherapy following radical prostatectomy. With new treatment techniques like Intensity Modulated Radiotherapy, toxicity profiles will be kept low. Expert commentary: Patients with biochemical recurrence following radical prostatectomy with an early rise in prostate-specific antigen (PSA) will benefit most from postoperative radiotherapy. In this way, patients with only high risk pathological features can avoid unnecessary treatment and toxicity, and early intervention in progressing patients would not compromise the outcome.
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Affiliation(s)
- D Lipman
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - B R Pieters
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - Theo M De Reijke
- b Department of Urology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
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9
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Abstract
This article is a short review of PET tracers, which have been used in clinical routine in single institutions. Preliminary anecdotal research supports the use of PET techniques in therapy planning of prostate cancer. The existing literature is discussed. For external beam radiation therapy, the biological target volume definition can only be based on PET imaging. There are not yet any prospective and randomized trials available; therefore, single-institution experiences cannot yet be recommended as clinical routine.
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Affiliation(s)
- Kalevi J A Kairemo
- Department of Molecular Radiotherapy, Docrates Cancer Center, Saukonpaadenranta 2, Helsinki FI-00180, Finland; Department of Nuclear Medicine, Docrates Cancer Center, Saukonpaadenranta 2, Helsinki FI-00180, Finland; Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA.
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Gauvin S, Cerantola Y, Haberer E, Pelsser V, Probst S, Bladou F, Anidjar M. Initial single-centre Canadian experience with 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/CT) for biochemical recurrence in prostate cancer patients initially treated with curative intent. Can Urol Assoc J 2017; 11:47-52. [PMID: 28443145 DOI: 10.5489/cuaj.4068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION We sought to determine predictive factors (patient and prostate-specific antigen [PSA] characteristics) for 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/CT) positivity in the context of biochemical recurrence after local treatment of prostate cancer (PCa) with curative intent. METHODS This is a retrospective study including 60 18F-FCH PET/CT scans of patients with biochemical recurrence after initial radical prostatectomy (RP), external beam radiation therapy (EBRT), or focal high-intensity focused ultrasound (HIFU) with curative intent. The results were compared to findings on magnetic resonance imaging (MRI), computed tomography (CT), bone scan (BS), and histological analysis when available. Univariate analysis was performed to correlate results with patient characteristics. RESULTS Thirty-eight (63.3%) scans were positive, 17 (28.3%) negative, and 5 (8.3%) equivocal. Of the positive scans, 16 demonstrated local recurrence, 12 regional/distant lymph nodes, five bone metastasis, and five local and distant recurrences. Among the 22 PET/CTs showing metastasis, conventional imaging was performed in 16 patients (72.7%). Of these, it demonstrated the lesion(s) found on PET/CT in eight patients (50.0%), was negative in seven (43.8%), and equivocal in one (6.3%). The trigger PSA (p=0.04), prostate-specific antigen velocity (PSAV) (p=0.03), and prostate-specific antigen doubling time (PSADT) (p=0.046) were significantly different when comparing positive and negative scans. Patients with positive scans were more likely to have received EBRT initially (odds ratio [OR] 11.0, 95% confidence interval [CI] 2.2-55.3). A trigger PSA of 2.6 ng/mL had a sensitivity of 84% and specificity of 65% for a positive scan. PET/CT changed the clinical management plan in 17 patients (28.3%). CONCLUSIONS 18F-FCH PET/CT demonstrates a high detection rate for local and distant recurrences after localized PCa treatment. A trigger PSA above 2.6 ng/mL seems optimal for appropriate patient selection.
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Affiliation(s)
- Simon Gauvin
- Department of Radiology, Jewish General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Yannick Cerantola
- Department of Urology, Jewish General Hospital, Montreal, QC, Canada.,Department of Urology, University Hospital of Lausanne, Switzerland
| | - Eléonore Haberer
- Department of Radiology, Jewish General Hospital, McGill University Health Centre, Montreal, QC, Canada.,Department of Urology, Jewish General Hospital, Montreal, QC, Canada
| | - Vincent Pelsser
- Department of Radiology, Jewish General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Stephan Probst
- Department of Nuclear Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - Franck Bladou
- Department of Urology, Jewish General Hospital, Montreal, QC, Canada
| | - Maurice Anidjar
- Department of Urology, Jewish General Hospital, Montreal, QC, Canada
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Evangelista L, Cimitan M, Hodolič M, Baseric T, Fettich J, Borsatti E. The ability of 18F-choline PET/CT to identify local recurrence of prostate cancer. ACTA ACUST UNITED AC 2016; 40:3230-7. [PMID: 26428685 DOI: 10.1007/s00261-015-0547-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine when 18F-choline PET/CT can truly identify local recurrence of prostate cancer. METHODS 1031 patients from 3 European centers underwent (18)F-choline PET/CT (FCH PET/CT) for recurrent disease; 131 subjects (12.7%) showed a positive FCH uptake in the prostatic gland or prostatic fossa. Median age was 72 years (range 48-87 years), and the median PSA level at the time of FCH PET/CT scan was 4.41 ng/mL (0.22-18.13 ng/mL). 45 patients (34.4%) had a Gleason score (GS) >7, and the residual subjects had a GS ≤ 7. The assessment of true or false-positive FCH PET/CT findings was made by magnetic resonance imaging (n = 34) and/or biopsy in 75/131 cases. A χ (2) test and a Z Kolmogorov-Smirnov test were used to assess the correlation between clinical variables (age, PSA, GS, type of therapy) and FCH PET/CT findings. RESULTS FCH PET/CT resulted truly positive (TP) for recurrent disease in the prostatic gland/fossa in 59/75 patients (79%) and falsely positive (FP) in 16 subjects (21%). The median value of PSA at the time of FCH PET/CT scan was higher in TP as compared to FP, although not statistically significant (4.76 vs. 3.04 ng/mL p > 0.05). Similarly, median age, GS categories, and the type of therapy were similar between the two groups (p > 0.05). However, when matching GS categories and PSA values, we found that the number of patients with TP findings were higher in the case of a PSA > 2 ng/mL, independently from the GS (ranging between 74% and 92%). Conversely, FP rate ranged between 50% and 65% in patients with a PSA ≤ 2 ng/mL, especially in the case of GS ≤ 7, whereas FP was around 25% in those with a GS >7 and PSA > 2 ng/mL. CONCLUSIONS FCH PET/CT has a limited role in evaluation of prostatic gland/fossa recurrence, due to the physiological biodistribution of the radiopharmaceutical agent. However, in 70-90% of patients with a PSA >2 ng/mL, independently from GS, a focal FCH uptake is compatible with a true local recurrence.
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Affiliation(s)
- Laura Evangelista
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Via Gattamelata, 64, 35128, Padua, Italy.
| | - Marino Cimitan
- Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, PN, Italy
| | - Marina Hodolič
- Nuclear Medicine Research Department, IASON, Graz, Austria
| | - Tanja Baseric
- Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, PN, Italy
| | - Jure Fettich
- Nuclear Medicine Department, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Eugenio Borsatti
- Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, PN, Italy
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Evangelista L, Briganti A, Fanti S, Joniau S, Reske S, Schiavina R, Stief C, Thalmann GN, Picchio M. New Clinical Indications for 18 F/ 11 C-choline, New Tracers for Positron Emission Tomography and a Promising Hybrid Device for Prostate Cancer Staging: A Systematic Review of the Literature. Eur Urol 2016; 70:161-175. [DOI: 10.1016/j.eururo.2016.01.029] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/20/2016] [Indexed: 01/05/2023]
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García J, Cozar M, Soler M, Bassa P, Riera E, Ferrer J. Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using 11 C-choline PET/CT. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Acquisition with (11)C-choline and (18)F-fluorocholine PET/CT for patients with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Ann Nucl Med 2016; 30:385-92. [PMID: 27173771 DOI: 10.1007/s12149-016-1078-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
The objective of the systematic review and meta-analysis was to evaluate whether the choice between two radiotracers, (11)C-choline ((11)C-cho) and (18)F-fluorocholine ((18)F-FCH) for PET/CT, and different acquisition protocols contributed to detect metastases for patients with biochemical recurrence of prostate cancer after radical prostatectomy or radiotherapy. We searched in January 2016 in Pubmed and Embase for articles that had used radiolabeled choline PET/CT in restaging. The meta-analysis evaluated technical and clinical aspects. Across 18 articles 1 219 of 2 213 patients (54.9 %) had a positive radiolabeled PET/CT image. Mean of the mean/median restaging PSA levels was 3.6 ± 2.7 ng/mL (range 0.5-10.7 ng/mL). Six articles with (11)C-cho PET/CT had a radiation activity of 561 ± 122 MBq and it was 293 ± 47 MBq in 12 articles with (18)F-FCH PET/CT. The difference was significant (P = 0.007, t test). Uptake time was 5 min in articles with (11)C-cho PET/CT and it was 29 ± 24 min in articles with (18)F-FCH PET/CT. The difference was significant (P = 0.02, t test). Thereby the detection rates of metastatic sites in articles with (11)C-cho (30 ± 5 %) and (18)F-FCH (39 ± 5 %) did not differ significantly (P = 0.26, t test). In linear regression analyses of the articles, the radiation activity of (11)C-cho and (18)F-FCH was not significantly associated with the detection rate of metastatic sites (P = 0.75 and P = 0.60). Restaging with radiolabeled choline PET/CT detected metastatic sites for patients with biochemical recurrence and PSA levels of 1-10 ng/mL at clinically relevant level. The choice between the two choline radiotracers and different acquisition protocols had no significant impact on detection.
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Nieder C, Marienhagen K, Kristensen RM, Sørbye T, Hoem L. Continuous prostate-specific antigen rise despite salvage radiotherapy following radical prostatectomy: Pattern of clinical relapse and predictive factors. Oncol Lett 2016; 11:1138-1142. [PMID: 26893707 DOI: 10.3892/ol.2015.4005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 11/10/2015] [Indexed: 11/05/2022] Open
Abstract
Salvage radiotherapy for post-prostatectomy biochemical recurrence does not always control the disease. It would be useful to identify patients who would not benefit from radiotherapy to the prostate bed prior to making treatment recommendations. One such group of patients is those who experience continuously rising prostate-specific antigen (PSA) despite radiotherapy. The purpose of this study was to identify risk factors for continuous PSA increase and the pattern of radiological relapse during follow-up. We performed a retrospective comparison of two patient groups with PSA decline or continuous increase following salvage radiotherapy to the prostate bed. All patients received 3-D conformal radiotherapy (35 fractions of 2 Gy). Patients with continuous PSA increase were more likely to have had complete surgical resection (negative margins) and a shorter interval to radiotherapy (<24 months). However, the only statistically significant risk factor was Gleason score. Sixty-four percent of patients with a Gleason score of 9 developed continuously increasing PSA, indicating that residual subclinical cancer was not located in the prostate bed. The median time to radiological recurrence was 43 months. Isolated pelvic nodal recurrence was uncommon. Almost all patients with radiological recurrence had high-risk disease, in particular stage pT3. In conclusion, the majority of patients with biologically aggressive tumors with Gleason score 9 were not adequately treated with prostate bed radiotherapy alone. The predominant pattern of radiological recurrence was outside of the pelvis. Therefore, the problem of distant micrometastases has to be addressed.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø 8092, Norway; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø 6038, Norway
| | - Kirsten Marienhagen
- Department of Oncology, University Hospital of North Norway, Tromsø 9038, Norway
| | | | | | - Lars Hoem
- Department of Urology, Nordland Hospital, Bodø 8092, Norway
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García JR, Cozar M, Soler M, Bassa P, Riera E, Ferrer J. Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using (11)C-choline PET/CT. Rev Esp Med Nucl Imagen Mol 2016; 35:238-45. [PMID: 26803491 DOI: 10.1016/j.remn.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the prognostic value of the therapeutic response by (11)C-choline PET/CT in prostate cancer patients with biochemical recurrence in which (11)C-choline PET/CT indicated radio-guided radiotherapy. METHODS The study included 37 patients initially treated with prostatectomy, who were treated due to biochemical recurrence. (11)C-choline PE/CT detected infra-diaphragmatic lymph-node involvement. All were selected for intensity modulated radiation therapy, escalating the dose according to the PET findings. One year after treatment patients underwent PSA and (11)C-choline PET/CT categorizing response (complete/partial/progression). Clinical/biochemical/image monitoring was performed until appearance of second relapse or 36 months in disease-free patients. RESULTS (11)C-choline PET/CT could detect lymph nodes in all 37 patients. They were 18 (48.6%) of more than a centimetre in size and 19 (51.3%) with no pathological CT morphology: 9 (24.3%) with positive lymph nodes of around one centimetre and 10 (27.0%) only less than a centimetre in size. The response by (11)C-choline PET/CT was categorised one year after radiotherapy: 16 patients (43.2%) complete response; 15 (40.5%) partial response, and 6 (16.2%) progression. The response was concordant between the PSA result and (11)C-choline PET/CT in 32 patients (86.5%), and discordant in five (13.5%). New recurrence was detected in 12 patients (80%) with partial response, and 5 (31.2%) with complete response. The mean time to recurrence was 9 months after partial response, and 18 months after complete response (significant difference, p<.0001). CONCLUSION (11)C-choline PET/CT allows the selection of patients with recurrent prostate cancer candidates for radiotherapy and to plan the technique. The evaluation of therapeutic response by (11)C-choline PET/CT has prognostic significance.
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Affiliation(s)
- J R García
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España.
| | - M Cozar
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| | - M Soler
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| | - P Bassa
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| | - E Riera
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| | - J Ferrer
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
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Arcangeli S, Ramella S, De Bari B, Franco P, Alongi F, D’Angelillo RM. A cast of shadow on adjuvant radiotherapy for prostate cancer: A critical review based on a methodological perspective. Crit Rev Oncol Hematol 2016; 97:322-7. [DOI: 10.1016/j.critrevonc.2015.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/14/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022] Open
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Ceci F, Castellucci P, Graziani T, Schiavina R, Fanti S. PET/Computed Tomography in the Individualization of Treatment of Prostate Cancer. PET Clin 2015; 10:487-94. [PMID: 26384595 DOI: 10.1016/j.cpet.2015.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Choline PET/computed tomographic (CT) imaging represents the most diffused PET imaging techniques to investigate patients with prostate cancer (PCa). It may show the site of tumor recurrence in a single step examination, earlier than other conventional imaging techniques. In this context, the availability of a diagnostic test capable of differentiating between potentially curable local recurrence and metastatic disease implying palliative approaches may play an important role in those patients in whom targeted therapies could be performed according to choline PET/CT results. This review analyzes the value of choline PET/CT imaging in the evaluation of treatment of patients with PCa.
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Affiliation(s)
- Francesco Ceci
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Paolo Castellucci
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Tiziano Graziani
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Stefano Fanti
- Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
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Detection of local recurrence of prostate cancer after radical prostatectomy: Is there a role for early ¹⁸F-FCH PET/CT? Ann Nucl Med 2015; 29:861-9. [PMID: 26261000 DOI: 10.1007/s12149-015-1015-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/03/2015] [Indexed: 01/12/2023]
Abstract
AIM To investigate the diagnostic performance of early acquisition compared to late imaging for the detection of local recurrence of prostate cancer by means of ¹⁸F-FCH PET/CT. MATERIALS AND METHODS 99 patients with radical prostatectomy (mean PSA 3.9 ± 5.03) were subjected to early dynamic PET/CT acquisition of the pelvis and a whole body PET/CT in the same exam session. None of the patients examined was subjected to radiotherapy for local or distant recurrence. All the subjects were taken off hormonal therapy. RESULTS 58 subjects did not show local recurrence in both early and late acquisition, 22 were positive in both modalities, 10 showed a positive early and a negative late acquisition while 9 showed a negative early and a positive late acquisition (Cohen's k = 0.558). When the results of imaging modalities were considered separately, sensitivity, specificity, positive predictive value and negative predictive value resulted: 78.9, 96.7, 93.8 and 88.1 % for early acquisition and 73.7, 95.1, 90.3 and 85.3 % for late acquisition, respectively. When the results of early and late acquisition were considered together, results were 97.4, 93.4, 90.2 and 98.3 %, respectively. CONCLUSIONS The combination of early acquisition with late acquisition lead to an increase of the diagnostic accuracy of ¹⁸F-FCH PET/CT for the diagnosis of local recurrence in prostate cancer.
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Kuang Y, Wu L, Hirata E, Miyazaki K, Sato M, Kwee SA. Volumetric modulated arc therapy planning for primary prostate cancer with selective intraprostatic boost determined by 18F-choline PET/CT. Int J Radiat Oncol Biol Phys 2015; 91:1017-25. [PMID: 25832692 PMCID: PMC4405528 DOI: 10.1016/j.ijrobp.2014.12.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE This study evaluated expected tumor control and normal tissue toxicity for prostate volumetric modulated arc therapy (VMAT) with and without radiation boosts to an intraprostatically dominant lesion (IDL), defined by (18)F-choline positron emission tomography/computed tomography (PET/CT). METHODS AND MATERIALS Thirty patients with localized prostate cancer underwent (18)F-choline PET/CT before treatment. Two VMAT plans, plan79 Gy and plan100-105 Gy, were compared for each patient. The whole-prostate planning target volume (PTVprostate) prescription was 79 Gy in both plans, but plan100-105 Gy added simultaneous boost doses of 100 Gy and 105 Gy to the IDL, defined by 60% and 70% of maximum prostatic uptake on (18)F-choline PET (IDLsuv60% and IDLsuv70%, respectively, with IDLsuv70% nested inside IDLsuv60% to potentially enhance tumor specificity of the maximum point dose). Plan evaluations included histopathological correspondence, isodose distributions, dose-volume histograms, tumor control probability (TCP), and normal tissue complication probability (NTCP). RESULTS Planning objectives and dose constraints proved feasible in 30 of 30 cases. Prostate sextant histopathology was available for 28 cases, confirming that IDLsuv60% adequately covered all tumor-bearing prostate sextants in 27 cases and provided partial coverage in 1 case. Plan100-105 Gy had significantly higher TCP than plan79 Gy across all prostate regions for α/β ratios ranging from 1.5 Gy to 10 Gy (P<.001 for each case). There were no significant differences in bladder and femoral head NTCP between plans and slightly lower rectal NTCP (endpoint: grade ≥ 2 late toxicity or rectal bleeding) was found for plan100-105 Gy. CONCLUSIONS VMAT can potentially increase the likelihood of tumor control in primary prostate cancer while observing normal tissue tolerances through simultaneous delivery of a steep radiation boost to a (18)F-choline PET-defined IDL.
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Affiliation(s)
- Yu Kuang
- Department of Medical Physics, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Lili Wu
- Department of Medical Physics, University of Nevada Las Vegas, Las Vegas, Nevada; Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Emily Hirata
- Hamamatsu/Queen's PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen's Medical Center, Honolulu, Hawaii
| | - Kyle Miyazaki
- Hamamatsu/Queen's PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen's Medical Center, Honolulu, Hawaii
| | - Miles Sato
- Hamamatsu/Queen's PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen's Medical Center, Honolulu, Hawaii
| | - Sandi A Kwee
- Hamamatsu/Queen's PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen's Medical Center, Honolulu, Hawaii; John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
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Zilli T, Miralbell R. In Regard to D'Angelillo et al. Int J Radiat Oncol Biol Phys 2015; 91:681-2. [DOI: 10.1016/j.ijrobp.2014.10.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
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In Reply to Zilli and Miralbell. Int J Radiat Oncol Biol Phys 2015; 91:682. [DOI: 10.1016/j.ijrobp.2014.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022]
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Oyen WJG, De Jong IJ. Molecular imaging of prostate cancer: tapping into the opportunities. J Nucl Med 2015; 56:169-70. [PMID: 25552669 DOI: 10.2967/jnumed.114.150219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Wim J G Oyen
- Radboud University Medical Center Nijmegen, The Netherlands
| | - Igle J De Jong
- University Medical Center Groningen Groningen, The Netherlands
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