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De Visschere PJ, Standaert C, Fütterer JJ, Villeirs GM, Panebianco V, Walz J, Maurer T, Hadaschik BA, Lecouvet FE, Giannarini G, Fanti S. A Systematic Review on the Role of Imaging in Early Recurrent Prostate Cancer. Eur Urol Oncol 2019; 2:47-76. [DOI: 10.1016/j.euo.2018.09.010] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 12/20/2022]
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Wei J, Zhu H, Liao X. Trigger pSA predicting recurrence from positive choline PET/CT with prostate cancer after initial treatment. Oncotarget 2018; 9:14630-14641. [PMID: 29581869 PMCID: PMC5865695 DOI: 10.18632/oncotarget.24318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/13/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose To assess the relationship between the diagnostic accuracy of Choline positron emission tomography/computed tomography (PET/CT) and the trigger prostate-specific antigen (PSA) level in patients with a biochemical recurrence of prostate cancer. Materials and Methods A meta-analysis was conducted to synthesize data across multiple studies. Results The pooled sensitivity and specificity of choline PET/CT were 82% (95% Confidence Interval (CI):80-84%) and 92% (95%CI: 90-93%), respectively. The pooled sensitivity and specificity of 18F-choline PET/CT were 81% (95%CI: 78-84%) and 90% (95%CI: 85-93%), respectively. The pooled sensitivity and specificity of 11C-choline PET/CT were 83% (95% CI: 80-86%) and 92% (95% CI: 90-94%), respectively. The pooled detection rate of 18F-choline PET/CT and 11C-choline PET/CT were 58% (95% CI: 48-68%) and 58% (95%CI: 49-68%), respectively. Conclusions Trigger PSA is an important risk factor for positive findings of Choline PET/CT and the detection rate of Choline PET/CT for recurrent prostate cancer increased in parallel with raises in PSA-values. Choline PET/CT got higher detection rate while the trigger PSA > 2ng/ml.
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Affiliation(s)
- Junbao Wei
- Department of Therapeutic Radiology, Guangxi Autonomous Regional Cancer Hospital & Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Hengzong Zhu
- Department of General Medicine, Longan Hospital of Traditional Chinese Medicine, Nanning, 532700, China
| | - Xiaoli Liao
- The Oncology Department, Guangxi Autonomous Regional Cancer Hospital & Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
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Mapelli P, Incerti E, Ceci F, Castellucci P, Fanti S, Picchio M. 11C- or 18F-Choline PET/CT for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer. J Nucl Med 2017; 57:43S-48S. [PMID: 27694171 DOI: 10.2967/jnumed.115.169755] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/27/2016] [Indexed: 01/02/2023] Open
Abstract
Recurrence of prostate cancer is suspected when an increase in the prostate-specific antigen level is detected after radical treatment; the recurrence could be local relapse, distant relapse, or both. Differentiation between the two patterns of relapse is critical for choosing the proper treatment strategy. Choline PET/CT could be of help in discriminating patients with local, lymph node, and bone recurrences, thus having an impact on patient management.
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Affiliation(s)
- Paola Mapelli
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Elena Incerti
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Francesco Ceci
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Castellucci
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Picchio
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
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Abstract
18F-fluorocholine (FCH) PET/computed tomography (CT) is a valuable imaging modality in prostate cancer disease. Probably, its main role is restaging of patients with biochemical recurrence after radical prostatectomy or external beam radiotherapy. 18F-FCH PET/CT is strengthening its position in the initial staging, biopsy target definition, radiotherapy planning, and therapy monitoring. Gleason score and prostate-specific antigen value, doubling time, and velocity can influence positivity of 18F-FCH PET/CT. The influence of androgen deprivation therapy on choline uptake is not precisely clarified. Collaboration between nuclear medicine physicians, radiologists, urologists, oncologists, and radiotherapists is crucial to help patients with prostate cancer disease.
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Affiliation(s)
- Marina Hodolič
- Nuclear Medicine Research Department, Iason, Graz, Austria; Department of Nuclear Medicine, Palacký University Olomouc, Olomouc, Czech Republic.
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Kallur KG, Ramachandra PG, Rajkumar K, Swamy SS, Desai I, Rao RM, Patil SG, Sridhar PS, Madhusudhan N, Krishnappa RS, Bhadrasetty V, Kumara HM, Santhosh SD, Ajaikumar BS. Clinical Utility of Gallium-68 PSMA PET/CT Scan for Prostate Cancer. Indian J Nucl Med 2017; 32:110-117. [PMID: 28533638 PMCID: PMC5439210 DOI: 10.4103/0972-3919.202255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Prostate cancer is biologically and clinically a heterogeneous disease that makes imaging evaluation challenging. One of the important challenges in this cancer is to detect recurrent disease. Biochemical response using Prostate Specific Antigen (PSA) and Imaging using several PET tracers have poor sensitivity and specificity. Therefore, we analyse the role of Ga68-PSMA (Prostate Specific Membrane Antigen) imaging in prostate cancer, which is a new PET tracer. METHODS In this study, we evaluated PET scans of 262 patients with diagnosis of prostate cancer. These patients were scanned using Ga68-PSMA for either staging or response evaluation. RESULTS 336 PSMA scans were performed. Ga68-PSMA scan resulted in the detection of extra-prostatic disease in 53.2% of cases when done at baseline before commencing any treatment. The sensitivity of Ga68-PSMA at baseline with histopathological diagnosis was 95% with 95% CI ranging from 86% to 98%. The positive predictive value was high at 98% with 95% CI ranging from 91% to 99%. In 26 (10%) patients who had surgical castration, Ga68-PSMA scan was able to detect disease progression / castration resistance in 100% of cases. The outcome of castration-resistant prostate cancer was compared with other cases where castration was not done. In those who did not undergo castration, there was a significantly better response by hormone therapy (p = 0.03) and radiotherapy (p = 0.01) on Ga68-PSMA. The sensitivity of Ga68-PSMA response with biochemical response was 66.7% with 95% CI ranging between 46 %- 82.7%. Ga68-PSMA response did not correlate with biochemical response. CONCLUSION Ga68-PSMA has good sensitivity for diagnosis, staging, restaging, evaluation of therapy response and prognostication in prostate cancer.
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Affiliation(s)
| | | | | | | | - Indiresh Desai
- Dept of Molecular Imaging, HCG Foundation, Bengaluru, India
| | | | | | - P S Sridhar
- Dept of Radiation Oncology, HCG Enterprises ltd, Bengaluru, India
| | | | | | | | | | - S D Santhosh
- Dept of Radiopharmacy, HCG Enterprises ltd, Bengaluru, India
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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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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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Optimized protocol for (18)F-choline PET/CT in patients with biochemically relapsed prostate cancer: experiences on 250 consecutive cases. Clin Nucl Med 2015; 40:e308-12. [PMID: 25742236 DOI: 10.1097/rlu.0000000000000757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE We review acquisition F-choline PET/CT methodology, evaluate a new F-choline acquisition protocol for prostate cancer (PC), and propose a standardized acquisition protocol on F-choline in PC patients. MATERIALS Two hundred fifty consecutive PC patients (mean age 72 years, mean PSA 7.9 ng/mL) were prospectively evaluated with F-choline PET/CT. An early scan of the pelvis (1 bed position of 4 minutes) was followed by a whole-body scan at 1 hour. Early and 1 delayed hour images of the pelvis were compared. RESULTS Twenty-one percent of patients (n = 57) with positive F-choline demonstrated abnormal local uptake; 18% of patients (n = 45) showed distant localization only; 23% of patients (n = 53) had both local and distant localization; 38% of patients (n = 38) did not show any pathological uptake. All early images showed absence of radioactive urine in ureters, bladder, or urethra with satisfactory visualization of the prostatic region. Considering the group of patients with local uptake only, the prostatic region uptake, confirmed by late images, was better visualized in the early phase in 32/57 cases (SUVmax 12.4 ± 3.2 vs. 7.3 ± 5.2, P <0.01). Instead distant lesions were visualized on both early and late images with similar uptakes values (SUVmax 9.8 ± 4.1 vs. 10.3 ± 4.5, P = N.S.). CONCLUSION Early F-choline images improve pelvic prostate cancer lesion clarity. All pathologic pelvic deposits (prostate, lymph nodes, bone) were visualized both in the early and late images.
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10
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Evangelista L, Cervino AR, Guttilla A, Zattoni F, Cuccurullo V, Mansi L. ¹⁸F-fluoromethylcholine or ¹⁸F-fluoroethylcholine pet for prostate cancer imaging: which is better? A literature revision. Nucl Med Biol 2015; 42:340-8. [PMID: 25618796 DOI: 10.1016/j.nucmedbio.2014.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/22/2014] [Accepted: 12/28/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The present review was conceived for describing the differences in biodistribution and diagnostic performance of two types of (18)F-radiolabeled choline for positron emission tomography (PET) imaging in prostate cancer (PCa), such as fluoromethylcholine (FCH) and fluoroethylcholine (FEC). MATERIALS AND METHODS A collection of published data about two radiopharmaceutical agents was made by using PubMed, Web of Knowledge databases and Trip Database, and then a critical revision was discussed. RESULTS FCH was injected in 338 and 1164 patients, while FEC was injected in 20 and 139 patients, respectively for basal staging and re-staging. The diagnostic performances of FCH and FEC for the detection of lymph node metastasis before the surgical approach are typically around 50% or less and between 0% and 39%, respectively. Conversely, both the tracers appear useful for the detection of recurrent PCa in case of increase in absolute PSA value or in case of high levels of PSA velocity and PSA doubling time (sensitivity ranged between 42.9% and 96% for FCH and between 62% and 85.7% for FEC). CONCLUSIONS In according with the available information, FCH appears to be a more appropriate radiocompound as compared to FEC, although more comparative data are mandatory. A well designed and prospective trial for the evaluation of biokinetic data and diagnostic performance of both radiopharmaceutical agents seems essential. ADVANCES IN KNOWLEDGE AND IMPLICATION FOR PATIENT CARE FCH seems to be an appropriate radiopharmaceutical agent as compared to FEC. Anyway both the radiocompounds are useful in the evaluation of recurrent disease in case of a serial increase in PSA value and their performance improves when a correct preparation and acquisition protocol is employed.
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Affiliation(s)
- Laura Evangelista
- Radiotherapy and Nuclear Medicine Unit, Oncological Institute of Veneto IOV-IRCCS, Padua, Italy.
| | - Anna Rita Cervino
- Radiotherapy and Nuclear Medicine Unit, Oncological Institute of Veneto IOV-IRCCS, Padua, Italy
| | - Andrea Guttilla
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Italy
| | - Fabio Zattoni
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Italy
| | | | - Luigi Mansi
- Nuclear Medicine, Second University of Naples, Napoli, Italy
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Navarro-Pelayo Láinez MM, Rodríguez-Fernández A, Gómez-Río M, Vázquez-Alonso F, Cózar-Olmo JM, Llamas-Elvira JM. The role of positron emission tomography/computed tomography imaging with radiolabeled choline analogues in prostate cancer. Actas Urol Esp 2014; 38:613-21. [PMID: 24548475 DOI: 10.1016/j.acuro.2013.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/01/2013] [Indexed: 12/24/2022]
Abstract
INTRODUCTION prostate cancer is the most frequent solid malignant tumor in Western Countries. Positron emission tomography/x-ray computed tomography imaging with radiolabeled choline analogues is a useful tool for restaging prostate cancer in patients with rising prostate-specific antigen after radical treatment (in whom conventional imaging techniques have important limitations) as well as in the initial assessment of a selected group of prostate cancer patients. For this reason a literature review is necessary in order to evaluate the usefulness of this imaging test for the diagnosis and treatment of prostate cancer. EVIDENCE ACQUISITION a MEDLINE (PubMed way) literature search was performed using the search parameters: «Prostate cancer» and «Choline-PET/CT». Other search terms were «Biochemical failure» and/or «Staging» and/or «PSA kinetics». English and Spanish papers were selected; original articles, reviews, systematic reviews and clinical guidelines were included. CONCLUSIONS according to available data, radiolabeled choline analogues plays an important role in the management of prostate cancer, especially in biochemical relapse because technique accuracy is properly correlated with prostate-specific antigen values and kinetics. Although is an emerging diagnostic technique useful in treatment planning of prostate cancer, final recommendations have not been submitted.
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Affiliation(s)
| | - A Rodríguez-Fernández
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M Gómez-Río
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - F Vázquez-Alonso
- Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J M Cózar-Olmo
- Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J M Llamas-Elvira
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
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New acquisition protocol of 18F-choline PET/CT in prostate cancer patients: review of the literature about methodology and proposal of standardization. BIOMED RESEARCH INTERNATIONAL 2014; 2014:215650. [PMID: 25121090 PMCID: PMC4119889 DOI: 10.1155/2014/215650] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/03/2014] [Accepted: 06/09/2014] [Indexed: 01/02/2023]
Abstract
Purpose. (1) To evaluate a new acquisition protocol of 18F-choline (FCH) PET/CT for prostate cancer patients (PC), (2) to review acquisition 18F-choline PET/CT methodology, and (3) to propose a standardized acquisition protocol on FCH PET/CT in PC patients. Materials. 100 consecutive PC patients (mean age 70.5 years, mean PSA 21.35 ng/mL) were prospectively evaluated. New protocol consisted of an early scan of the pelvis immediately after the injection of the tracer (1 bed position of 4 min) followed by a whole body scan at one 1 hour. Early and 1 hour images were compared for interfering activity and pathologic findings. Results. The overall detection rate of FCH PET/CT was 64%. The early static images of the pelvis showed absence of radioactive urine in ureters, bladder, or urethra which allowed a clean evaluation of the prostatic fossae. Uptake in the prostatic region was better visualized in the early phase in 26% (7/30) of cases. Other pelvic pathologic findings (bone and lymph nodes) were visualized in both early and late images. Conclusion. Early 18F-choline images improve visualization of abnormal uptake in prostate fossae. All pathologic pelvic deposits (prostate, lymph nodes, and bone) were visualized in both early and late images.
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Abdollah F, Briganti A, Montorsi F, Stenzl A, Stief C, Tombal B, Van Poppel H, Touijer K. Contemporary role of salvage lymphadenectomy in patients with recurrence following radical prostatectomy. Eur Urol 2014; 67:839-49. [PMID: 24698524 DOI: 10.1016/j.eururo.2014.03.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/17/2014] [Indexed: 11/17/2022]
Abstract
CONTEXT Prostate cancer (PCa) patients with isolated clinical lymph node (LN) relapse, limited to the regional and/or retroperitoneal LNs, may represent a distinct group of patients who have a more favorable outcome than men with progression to the bone or to other visceral organs. Some data indirectly denote a beneficial impact of pelvic LN dissection on survival in these patients. OBJECTIVE To provide an overview of the currently available literature regarding salvage LN dissection (SLND) in PCa patients with clinical relapse limited to LNs after radical prostatectomy (RP). EVIDENCE ACQUISITION A systematic literature search was conducted using the Medline, Embase, and Web of Science databases to identify original articles, review articles, and editorials regarding SLND. Articles published between 2000 and 2012 were reviewed and selected with the consensus of all the authors. EVIDENCE SYNTHESIS Contemporary imaging techniques, such as 11C-choline positron emission tomography and diffusion-weighted magnetic resonance imaging, appear to enhance the accuracy in identifying LN relapse in patients with biochemical recurrence (BCR) and after RP. In these individuals, SLND can be considered as a treatment option. The currently available data suggest that SLND can delay clinical progression and postpone hormonal therapy in almost one-third of the patients, although the majority will have BCR. An accurate and attentive preoperative patient selection may help improve these outcomes. The most frequent complication after SLND was lymphorrhea (15.3%), followed by fever (14.5%) and ileus (11.2%). It is noteworthy that all examined cohorts originated from retrospective single-institution series, with limited sample size and short follow-up. Consequently, the current findings cannot be generalized and warrant further investigation in future prospective trials. CONCLUSIONS The current data suggest that SLND represents an option in patients with disease relapse limited to the LNs after RP; however, more robust data derived from well-designed clinical trials are needed to validate the role of SLND in this selected patient population. PATIENT SUMMARY Salvage lymph node dissection (SLND) represents a treatment option in for patients with prostate cancer relapse limited to the lymph nodes; however, more robust data derived from well-designed clinical trials are needed to validate the role of SLND in this selected patient population.
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Affiliation(s)
- Firas Abdollah
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
| | - Alberto Briganti
- Department of Urology, Vita-Salute University, San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita-Salute University, San Raffaele, Milan, Italy
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Christian Stief
- Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany
| | - Bertrand Tombal
- Service d'Urologie, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Hein Van Poppel
- Department of Urology, Leuven Cancer Institute, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Suardi N, Gandaglia G, Gallina A, Di Trapani E, Scattoni V, Vizziello D, Cucchiara V, Bertini R, Colombo R, Picchio M, Giovacchini G, Montorsi F, Briganti A. Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol 2014; 67:299-309. [PMID: 24571959 DOI: 10.1016/j.eururo.2014.02.011] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 02/07/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prostate cancer (PCa) patients with lymph node recurrence after radical prostatectomy (RP) are usually managed with androgen-deprivation therapy. Despite the absence of prospective randomized studies, salvage lymph node dissection (LND) has been proposed as an alternative treatment option. OBJECTIVE To examine long-term outcomes of salvage LND in patients with nodal recurrent PCa documented by 11C-choline positron emission tomography/computed tomography (PET/CT) scan. DESIGN, SETTING, AND PARTICIPANTS Overall, 59 patients affected by biochemical recurrence (BCR) with 11C-choline PET/CT scan with pathologic activity treated between 2002 and 2008 were included. INTERVENTION Pelvic and/or retroperitoneal salvage LND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Biochemical response (BR) was defined as prostate-specific antigen (PSA) <0.2 ng/ml at 40 d after surgery. BCR for those who achieved BR was defined as a PSA >0.2 ng/ml. Clinical recurrence (CR) was defined as a positive PET/CT scan after salvage LND in the presence of a rising PSA. Kaplan-Meier curves assessed time to BCR, CR, and cancer-specific mortality (CSM). Cox regression analyses were fitted to assess predictors of CR. RESULTS AND LIMITATIONS Median follow-up after salvage LND was 81.1 mo. Overall, 35 patients (59.3%) achieved BR. The 8-yr BCR-free survival rate in patients with complete BR was 23%. Overall, the 8-yr CR- and CSM-free survival rates were 38% and 81%, respectively. In multivariable analyses evaluating preoperative variables, PSA at salvage LND represented the only predictor of CR (p=0.03). When postoperative variables were considered, BR and the presence of retroperitoneal lymph node metastases were significantly associated with the risk of CR (all p ≤ 0.04). Our study is limited by the lack of a control group. CONCLUSIONS Salvage LND may represent a therapeutic option for patients with BCR after RP and nodal pathologic uptake at 11C-choline PET/CT scan. Although most patients progressed to BCR after salvage LND, roughly 40% of them experienced CR-free survival. PATIENT SUMMARY Salvage lymph node dissection may represent a therapeutic option for selected patients with nodal recurrence after radical prostatectomy. Roughly 40% of men did not show any further clinical recurrence at long-term follow-up after surgery.
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Affiliation(s)
- Nazareno Suardi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Scattoni
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Vizziello
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Bertini
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Renzo Colombo
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesco Montorsi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
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15
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Choline PET or PET/CT and biochemical relapse of prostate cancer: a systematic review and meta-analysis. Clin Nucl Med 2013; 38:305-14. [PMID: 23486334 DOI: 10.1097/rlu.0b013e3182867f3c] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The increase of prostate-specific antigen (PSA) after radical retropubic prostatectomy (RP) or external beam radiotherapy (EBRT) is the most sensitive tool for detecting prostate cancer (PCa) recurrence, although this measure cannot distinguish between local, regional, or distant recurrence. The aim of this meta-analysis was to evaluate the diagnostic performance of 18F-choline and 11C-choline PET or PET/CT in detection of locoregional or distant metastases in PCa. MATERIALS AND METHODS Medline, Web of Knowledge, and Google Scholar search was carried out in order to select English-language articles dealing with diagnostic performance of both 18F-choline and 11C-choline PET for the detection of PCa recurrence after RP or EBRT. Articles were included only if absolute numbers of true-positive, true-negative, false-positive, and false-negative test results were available or derivable from the text and regarded local, lymph node, and distant metastases. Reviews, clinical reports, and editorial articles were excluded. All complete studies were re-analyzed thus performing a quantitative analysis. RESULTS From the years 2000 to 2012, we found 53 complete articles that critically evaluated the role of choline PET in restaging patients with PCa recurrence. The meta-analysis was carried out and dealt with 19 selected studies (12 studies for all sites of disease, 3 for lymph node metastases, and 4 for local recurrence), with a total of 1555 patients. The meta-analysis provided a pooled sensitivity of 85.6% (95% CI: 82.9%-88.1%) and pooled specificity of 92.6% (95% CI: 90.1%-94.6%) for all sites of disease (prostatic fossa, lymph nodes, and bone), a pooled sensitivity of 75.4% (95% CI: 66.9%-82.6%) and pooled specificity of 82% (95% CI: 68.6%-91.4%) for prostatic fossa recurrence, and a pooled sensitivity of 100% (95% CI: 90.5%-100%) and pooled specificity of 81.8% (95% CI: 48.2%-97.7%) for lymph node metastases. The heterogeneity ranged between 0.00% and 88.6%. The diagnostic odds ratios were 62.123 (95% CI: 24.783-155.72), 5.869 (95% CI: 1.818-18.946), and 138.57 (95% CI: 11.27-1703.8), respectively, for all sites of disease, local recurrence, and lymph node disease. CONCLUSIONS Choline PET and PET/CT represent high sensitivity and specificity techniques for the detection of locoregional and distant metastases in PCa patients with recurrence of disease. Moreover, a high diagnostic odds ratio was found for the identification of lymph node disease in patients with biochemical recurrence of PCa.
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16
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Dost RJ, Glaudemans AWJM, Breeuwsma AJ, de Jong IJ. Influence of androgen deprivation therapy on choline PET/CT in recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2013; 40 Suppl 1:S41-7. [PMID: 23564037 DOI: 10.1007/s00259-013-2398-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Recurrent prostate cancer is usually treated by combining radiotherapy and androgen deprivation therapy. To stage the cancer, choline positron emission tomography (PET)/CT can be performed. It is generally thought that androgen deprivation therapy does not influence choline PET/CT. In this article we focus on the molecular backgrounds of choline and androgens, and the results of preclinical and clinical studies performed using PET/CT. METHODS Using PubMed, we looked for the relevant articles about androgen deprivation therapy and choline PET/CT. RESULTS During ADT, a tendency of decreased uptake of choline in prostate cancer was observed, in particular in hormone-naïve patients. CONCLUSION We conclude that in order to prevent false-negative choline PET/CT scans androgen deprivation should be withheld prior to scanning, especially in hormone-naïve patients.
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Affiliation(s)
- Rutger J Dost
- Department of Urology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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