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The Role of 11C-Choline PET Imaging in the Early Detection of Recurrence in Surgically Treated Prostate Cancer Patients With Very Low PSA Level <0.5 ng/mL

Mamede, Marcelo MD, PhD*†; Ceci, Francesco MD*; Castellucci, Paolo MD*; Schiavina, Riccardo MD; Fuccio, Chiara MD§; Nanni, Cristina MD*; Brunocilla, Eugenio MD; Fantini, Lorenzo MD*; Costa, Stefano BSc*; Ferretti, Alice MSc; Colletti, Patrick M. MD; Rubello, Domenico MD; Fanti, Stefano MD*

doi: 10.1097/RLU.0b013e31829af913
Original Articles

Purpose This study aims to evaluate the role of 11C-choline PET/CT in patients with biochemical relapse after radical prostatectomy (RP) showing prostate-specific antigen (PSA) values lower than 0.5 ng/mL.

Methods We performed 11C-choline PET/CT in 71 consecutive patients previously treated with RP showing PSA values lower than 0.5 ng/mL. 11C-Choline PET/CT was performed following standard procedure. 11C-Choline PET/CT–positive findings were validated by transrectal ultrasonography + biopsy, repeated 11C-choline PET/CT, other conventional imaging modality, and histology.

Results 11C-Choline PET/CT was true positive in 15/71 (21.1%). 11C-Choline uptake was observed in pelvic lymph nodes (7/71; 9.9%), in the prostatic bed (7/71; 9.9%), and in bone (1/71; 1.4%). Mean PSA, PSA doubling time (PSAdt), and PSA velocity (PSAvel) values ± SD in 11C-choline PET/CT–positive patients was 0.37 ± 0.1 ng/mL, 3.4 ± 2.1 months, and 0.05 ± 0.1 ng/mL/yr, respectively. 11C-Choline PET/CT was false negative in 2 patients and false positive in 1 patient. Among all variables, only PSAdt and the ongoing hormonal treatment were statistically significant in the prediction of a positive 11C-choline PET/CT at multivariate analysis.

Conclusions 11C-Choline PET/CT could be used early after biochemical failure even if PSA values are very low, preferentially in hormonal resistant patients showing fast PSA kinetics. An early detection of the site of relapse could lead to a personalized and tailored treatment.

From the *Department of Nuclear Medicine, Policlinico Sant’Orsola-Malpighi, Bologna, Italy; †Molecular Imaging Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; ‡Urology Unit, Policlinico Sant’Orsola-Malpighi, Bologna, Italy; §Department of Nuclear Medicine, Fondazione Salvatore Maugeri, Pavia, Italy; ¶Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy; and ∥Department of Radiology, University of Southern California, Los Angeles, CA.

Received for publication March 22, 2013; and revision accepted April 23, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Domenico Rubello, MD, Department of Imaging, Nuclear Medicine & PET Unit, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy. E-mail:

© 2013 by Lippincott Williams & Wilkins