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Role of 18F-Choline PET/CT in Biochemically Relapsed Prostate Cancer After Radical Prostatectomy: Correlation With Trigger PSA, PSA Velocity, PSA Doubling Time, and Metastatic Distribution

Marzola, Maria Cristina MD*; Chondrogiannis, Sotirios MD*; Ferretti, Alice MD; Grassetto, Gaia MD*; Rampin, Lucia MD*; Massaro, Arianna CNMT*; Castellucci, Paolo MD; Picchio, Maria MD§; Al-Nahhas, Adil MD; Colletti, Patrick M. MD; Marcolongo, Adriano MD#; Rubello, Domenico MD*

doi: 10.1097/RLU.0b013e318266cc38
Original Articles

Purpose: The aim of this study was to evaluate the efficacy of 18F-choline PET/CT (18FCH-PET/CT) in restaging patients previously treated by radical prostatectomy for a prostate cancer, presenting with biochemical relapse during follow-up (FU).

Patients and Methods: Three hundred thirty-one patients referred to us from January 2009 to April 2011 to perform 18FCH PET/CT were evaluated: 233 of them (mean age 69.7 years) met the inclusion criteria of the study: (1) biochemical relapse after radical prostatectomy (trigger PSA >0.2 ng/mL) (n = 224) and (2) high risk for relapse (elevated Gleason score ≥8) in spite PSA <0.1 ng/mL during FU (n = 9). Trigger PSA was available for all patients (mean 8 ng/mL) and in 44 of them also PSA kinetic (PSA velocity—PSAvel; PSA doubling time—PSAdt). Correlation between 18FCH PET/CT detection rate and trigger PSA, PSAvel, PSAdt, and tumoral spread distribution were evaluated by univariate and multivariate analysis. Subsequent minimum FU was 1 year (mean 26 months, range 12–40).

Results: Overall detection rate of 18FCH PET/CT was 54%, which significantly increased when the trigger PSA increases (P < 0.001). PET-positive patients presented a “fast” PSA kinetic (mean PSAdt = 6 months and mean PSAvel = 9.3 ng/mL/yr), while PET-negative patients presented a “slow” PSA kinetic (mean PSAdt = 15.4 months and mean PSAvel = 0.9 ng/mL/yr). Disease relapse was local in 17% of cases, distant in 66%, and combined in 17%.

Conclusions: Overall 18FCH PET/CT detection rate was 54% (ie, similar to that reported in literature with 11C-choline), which increases with the increase in trigger PSA: this condition was particularly true in patients with accelerated PSA kinetic. In about 20% of patients, 18FCH PET/CT demonstrated local relapses early enough to offer locoregional radiation therapy.

From the *Department of Nuclear Medicine, PET/CT Center, and †Medical Physics Unit, “Santa Maria della Misericordia” Hospital, Rovigo; ‡Department of Nuclear Medicine, “Policlinico Sant’ Orsola-Malpighi”, University of Bologna, Bologna; §Department of Nuclear Medicine, “San Raffaele” Scientific Institute, Milan, Italy; ∥Department of Nuclear Medicine, Hammersmith Hospital, London, UK; ¶Department of Radiology, University of Southern California, Los Angeles, CA; and #General Direction, “Santa Maria della Misericordia” Hospital, Rovigo, Italy.

Received for publication April 27, 2012; and revision accepted May 23, 2012.

Conflicts of interest and sources of funding: This study was partially funded by Veneto Region, Italy (Ricerca Sanitaria Finalizzata n. 308/2009 DGRV, 4273 del 29.12.2009).

Reprints: Domenico Rubello, MD, Department of Imaging, Head Service of Nuclear Medicine and PET/CT Center, “Santa Maria della Misericordia” Hospital, Via Tre Martiri 89, 45100 Rovigo, Italy. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.