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Prognostic value of 18F–choline PET/CT metabolic parameters in patients with metastatic castration-resistant prostate cancer treated with abiraterone or enzalutamide

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Abstract

Purpose

The role of 18F–choline positron emission tomography/computed tomography (FCH-PET/CT) in patients with metastatic castration-resistant prostate cancer (mCRPC) has been firmly established in recent years. We analyzed the prognostic value of functional parameters such as mean standardized uptake volume (SUVmean), maximum standardized uptake volume (SUVmax), metabolic total volume (MTV; the volume of interest consisting of all spatially connected voxels within a fixed threshold of 40% of the SUVmax), and total lesion activity (TLA: the product of MTV and mean standardized uptake value) estimated with FCH-PET/CT in mCRPC patients in progression after docetaxel and treated with new antiandrogen receptor therapies, abiraterone or enzalutamide.

Methods

We retrospectively studied 94 mCRPC patients, mean age 74 years (range 42–90), previously treated with docetaxel who were treated with either abiraterone (n = 52) or enzalutamide (n = 42). An FCH-PET/CT was performed at baseline, and patients were evaluated on a monthly basis for serological PSA response and every 3 months for radiological response. We measured MTV, SUVmean, SUVmax and TLA for each lesion and analyzed the sum of MTV (SMTV), SUVmean (SSUVmean), SUVmax (SSUVmax) and TLA (STLA) values for a maximum of 20 lesions. Univariate analysis was used to correlate these data with PFS and OS.

Results

We observed a median SMTV of 130 cm3, median SSUVmax of 106.5 and a median STLA of 495,070. All of these parameters were significant for PFS and OS in univariate analysis, while only STLA was significant for PFS and OS in multivariate analysis after adjusting for lesion and age (p < 0.0001 and p = 0.001, respectively). Baseline PSA values maintained a certain reliability for OS (p = 0.034).

Conclusions

Semiquantitative parameters of FCH-PET/CT play a prognostic role in mCRCP patients treated with abiraterone or enzalutamide.

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Acknowledgements

The authors would like to thank Grainne Eileen Tierney for editorial assistance.

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Authors and Affiliations

  1. Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Paola Caroli, Lorenzo Fantini, Monica Celli, Giovanni Paganelli & Federica Matteucci

  2. Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Ugo De Giorgi, Vincenza Conteduca & Lorena Rossi

  3. Unit of Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Emanuela Scarpi

  4. Nuclear Medicine Unit, Morgagni Pierantoni Hospital, Forlì, Italy

    Andrea Moretti & Riccardo Galassi

  5. Department of Medical Oncology, Infermi Hospital, Rimini, Italy

    Emanuela Bianchi

Authors
  1. Paola Caroli
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  2. Ugo De Giorgi
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  3. Emanuela Scarpi
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  4. Lorenzo Fantini
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  5. Andrea Moretti
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  6. Riccardo Galassi
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  7. Monica Celli
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  8. Vincenza Conteduca
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  9. Lorena Rossi
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  10. Emanuela Bianchi
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  11. Giovanni Paganelli
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  12. Federica Matteucci
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Contributions

Study concepts and design: PC, UDG and FM.

Provision of study materials or patients: UDG, VC, EB and LR.

Collection and assembly of data: PC, FM, UDG and MS.

Diagnostic imaging: RG, AM, PC, MC, LF and FM.

Analysis and interpretation of data: PC, UDG, FM, PG and MS.

Drafting of manuscript: PC.

Critical revision of the manuscript for important intellectual content: FM and PG.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Paola Caroli.

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Ethical approval

The protocol was approved by the Ethics Committee of Area Vasta Romagna and by the competent Italian regulatory authorities. The study was performed in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice.

Informed consent

All patients gave their written informed consent.

Conflicts of interest

The authors declare that they have no competing interests.

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Caroli, P., De Giorgi, U., Scarpi, E. et al. Prognostic value of 18F–choline PET/CT metabolic parameters in patients with metastatic castration-resistant prostate cancer treated with abiraterone or enzalutamide. Eur J Nucl Med Mol Imaging 45, 348–354 (2018). https://doi.org/10.1007/s00259-017-3866-2

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  • DOI: https://doi.org/10.1007/s00259-017-3866-2

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