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11C-choline PET/CT predicts survival in prostate cancer patients with PSA < 1 NG/ml

  • Giampiero Giovacchini
  • Priscilla Guglielmo
  • Paola Mapelli
  • Elena Incerti
  • Ana Maria Samanes Gajate
  • Elisabetta Giovannini
  • Mattia Riondato
  • Alberto Briganti
  • Luigi Gianolli
  • Andrea Ciarmiello
  • Maria Picchio
Original Article

Abstract

Purpose

The main drawback of 11C-choline PET/CT for restaging prostate cancer (PCa) patients with biochemical failure is the relatively low positive detection rate for prostate specific antigen (PSA) < 1 ng/ml. This study assessed whether 11C-choline PET/CT predicts survival in PCa patients with PSA < 1 ng/ml.

Methods

This retrospective study included 210 PCa patients treated with radical prostatectomy who underwent 11C-choline PET/CT from December 1, 2004 to July 31, 2007 due to biochemical failure. PCa-specific survival was estimated using Kaplan–Meier curves. Cox regression analysis was used to evaluate the association between clinicopathologic variables and PCa-specific survival. PCa-specific survival was computed as the interval from radical prostatectomy to PCa-specific death.

Results

Median follow-up after radical prostatectomy was 6.9 years (95% confidence interval, CI, 2.0–14.5 years). 11C-choline PET/CT was positive in 20.5% of patients. Median PCa-specific survival was 13.4 years (95% CI, 9.9–16.8 years) in patients with positive 11C-choline PET/CT, and it was not achieved in patients with negative 11C-choline PET/CT (log-rank, chi-square = 15.0, P < 0.001). Ten-year survival probabilities for patients with negative 11C-choline PET/CT and for patients with positive 11C-choline PET/CT were 86.0% (95% CI: 80.7%–91.3%) and 63.6% (95% CI: 54.5–72.7%). At multivariate analysis, only 11C-choline PET/CT significantly predicted PCa-specific survival (hazard ratio = 2.54, 95% CI, 1.05–6.13, P = 0.038). Patients with pathological 11C-choline uptake in the prostatic bed or in pelvic lymph nodes had longer PCa-specific survival in comparison to patients with pathological tracer uptake in the skeleton (log-rank: chi-square = 27.4, P < 0.001).

Conclusion

Despite the relatively low positive detection rate for PSA < 1 ng/ml, positive 11C-choline PET/CT predicts PCa-specific survival in this low PSA range. As long as more sensitive radiotracers, such as 68Ga-PSMA-11, do not become more widely available, these results might support a broader use of radiolabeled choline in restaging PCa for PSA < 1 ng/ml.

Keywords

Prostate cancer 11C-choline PET/CT Survival Biochemical failure 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest and no research support from funding agencies or industry.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Giampiero Giovacchini
    • 1
  • Priscilla Guglielmo
    • 2
    • 3
  • Paola Mapelli
    • 3
    • 4
  • Elena Incerti
    • 3
  • Ana Maria Samanes Gajate
    • 3
  • Elisabetta Giovannini
    • 1
  • Mattia Riondato
    • 1
  • Alberto Briganti
    • 4
    • 5
  • Luigi Gianolli
    • 3
  • Andrea Ciarmiello
    • 1
  • Maria Picchio
    • 3
    • 4
  1. 1.Department of Nuclear MedicineS. Andrea HospitalLa SpeziaItaly
  2. 2.University of Milan-BicoccaMilanItaly
  3. 3.Department of Nuclear MedicineIRCCS San Raffaele Scientific InstituteMilanItaly
  4. 4.Vita-Salute San Raffaele UniversityMilanItaly
  5. 5.Department of UrologyIRCCS San Raffaele Scientific InstituteMilanItaly

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