Advertisement

Medical Oncology

, 36:67 | Cite as

Recurrent prostate cancer after radical prostatectomy: restaging performance of 18F-choline hybrid PET/MRI

  • Verane Achard
  • Giorgio Lamanna
  • Antoine Denis
  • Thomas De Perrot
  • Ismini Charis Mainta
  • Osman Ratib
  • Christophe Iselin
  • Raymond Miralbell
  • Valentina Garibotto
  • Thomas ZilliEmail author
Original Paper

Abstract

To evaluate the diagnostic performance of a whole-body 18F-choline (FCH) hybrid PET/MRI for prostate cancer patients at biochemical relapse after radical prostatectomy (RP) compared to pelvic multiparametric MRI (mpMRI), one of the standard imaging modality for this patient population. From 2010 to 2016, 58 whole-body FCH PET/MRI studies with mpMRI acquisitions were performed in 53 prostate cancer patients relapsing after curative RP. Median PSA and PSA doubling time (PSA DT) at PET study were 1.5 ng/ml and 6.5 months, respectively. The overall positivity rate of FCH PET/MRI was 58.6% (n = 34), dropping to 44% in patients with a PSA ≤ 2 ng/ml (n = 36). Median PSA values in positive and negative PET/MRI studies were 2.2 ng/ml and 0.8 ng/ml, respectively, with no differences in PSA DT (6.5 vs. 6.6 months). A PSA value ≥ 1.5 ng/ml was a significant predictor of positivity on PET/MRI studies. Compared to PET, mpMRI identified more local relapses (17 vs. 14, p = 0.453) while PET outperformed whole-body Dixon MRI for regional (16 vs. 9, p = 0.016) and distant (12 vs. 6, p = 0.031) metastases. Compared to pelvic mpMRI, the treatment approach turned out to be influenced more frequently using whole-body FCH hybrid PET/MRI studies (58.6% vs. 38%). In prostate cancer patients with biochemical recurrence after RP, whole-body FCH PET/MRI achieved a higher detection rate of nodal/distant metastases compared to pelvic mpMRI alone, increasing the change of treatment strategy by more than 20%.

Keywords

Prostate cancer Biochemical recurrence Radical prostatectomy Whole-body FCH hybrid PET/MRI Pelvic mpMRI 

Notes

Acknowledgements

This study has been funded by a research Grant from the “Fondation pour la lutte contre le cancer et pour des recherches médico-biologiques”, Geneva, Switzerland.

Author contributions

All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Albertsen PC, Hanley JA, Penson DF, Fine J. Validation of increasing prostate specific antigen as a predictor of prostate cancer death after treatment of localized prostate cancer with surgery or radiation. J Urol. 2004;171(6 Pt 1):2221–5.CrossRefGoogle Scholar
  2. 2.
    Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 1999;281(17):1591–7.CrossRefGoogle Scholar
  3. 3.
    Freedland SJ, Rumble RB, Finelli A, Chen RC, Slovin S, Stein MN, et al. Adjuvant and salvage radiotherapy after prostatectomy: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2014;32(34):3892–8.  https://doi.org/10.1200/JCO.2014.58.8525.CrossRefPubMedGoogle Scholar
  4. 4.
    Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, et al. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol. 2013;190(2):441–9.  https://doi.org/10.1016/j.juro.2013.05.032.CrossRefPubMedGoogle Scholar
  5. 5.
    Stish BJ, Pisansky TM, Harmsen WS, Davis BJ, Tzou KS, Choo R, et al. Improved metastasis-free and survival outcomes with early salvage radiotherapy in men with detectable prostate-specific antigen after prostatectomy for prostate cancer. J Clin Oncol. 2016;34(32):3864–71.  https://doi.org/10.1200/jco.2016.68.3425.CrossRefPubMedGoogle Scholar
  6. 6.
    Fanti S, Minozzi S, Antoch G, Banks I, Briganti A, Carrio I, et al. Consensus on molecular imaging and theranostics in prostate cancer. Lancet Oncol. 2018;19(12):e696–708.  https://doi.org/10.1016/S1470-2045(18)30604-1.CrossRefPubMedGoogle Scholar
  7. 7.
    Maurer T, Eiber M, Fanti S, Budaus L, Panebianco V. Imaging for prostate cancer recurrence. Eur Urol Focus. 2016;2(2):139–50.  https://doi.org/10.1016/j.euf.2016.02.006.CrossRefPubMedGoogle Scholar
  8. 8.
    Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol. 2017;71(4):630–42.  https://doi.org/10.1016/j.eururo.2016.08.002.CrossRefPubMedGoogle Scholar
  9. 9.
    Kitajima K, Murphy RC, Nathan MA, Froemming AT, Hagen CE, Takahashi N, et al. Detection of recurrent prostate cancer after radical prostatectomy: comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil. J Nucl Med. 2014;55(2):223–32.  https://doi.org/10.2967/jnumed.113.123018.CrossRefPubMedGoogle Scholar
  10. 10.
    Mitchell CR, Lowe VJ, Rangel LJ, Hung JC, Kwon ED, Karnes RJ. Operational characteristics of (11)c-choline positron emission tomography/computerized tomography for prostate cancer with biochemical recurrence after initial treatment. J Urol. 2013;189(4):1308–13.  https://doi.org/10.1016/j.juro.2012.10.069.CrossRefPubMedGoogle Scholar
  11. 11.
    Amzalag G, Rager O, Tabouret-Viaud C, Wissmeyer M, Sfakianaki E, de Perrot T, et al. Target definition in salvage radiotherapy for recurrent prostate cancer: the role of advanced molecular imaging. Front Oncol. 2016;6:73.  https://doi.org/10.3389/fonc.2016.00073.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Buchegger F, Garibotto V, Zilli T, Allainmat L, Jorcano S, Vees H, et al. First imaging results of an intraindividual comparison of (11)C-acetate and (18)F-fluorocholine PET/CT in patients with prostate cancer at early biochemical first or second relapse after prostatectomy or radiotherapy. Eur J Nucl Med Mol Imaging. 2014;41(1):68–78.  https://doi.org/10.1007/s00259-013-2540-6.CrossRefPubMedGoogle Scholar
  13. 13.
    Castellucci P, Ceci F, Graziani T, Schiavina R, Brunocilla E, Mazzarotto R, et al. Early biochemical relapse after radical prostatectomy: which prostate cancer patients may benefit from a restaging 11C-Choline PET/CT scan before salvage radiation therapy? J Nucl Med. 2014;55(9):1424–9.  https://doi.org/10.2967/jnumed.114.138313.CrossRefPubMedGoogle Scholar
  14. 14.
    Giovacchini G, Picchio M, Garcia-Parra R, Mapelli P, Briganti A, Montorsi F, et al. [11C]choline positron emission tomography/computerized tomography for early detection of prostate cancer recurrence in patients with low increasing prostate specific antigen. J Urol. 2013;189(1):105–10.  https://doi.org/10.1016/j.juro.2012.09.001.CrossRefPubMedGoogle Scholar
  15. 15.
    Schillaci O, Calabria F, Tavolozza M, Caracciolo CR, Finazzi Agro E, Miano R, et al. Influence of PSA, PSA velocity and PSA doubling time on contrast-enhanced 18F-choline PET/CT detection rate in patients with rising PSA after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2012;39(4):589–96.  https://doi.org/10.1007/s00259-011-2030-7.CrossRefPubMedGoogle Scholar
  16. 16.
    de Perrot T, Rager O, Scheffler M, Lord M, Pusztaszeri M, Iselin C, et al. Potential of hybrid (1)(8)F-fluorocholine PET/MRI for prostate cancer imaging. Eur J Nucl Med Mol Imaging. 2014;41(9):1744–55.  https://doi.org/10.1007/s00259-014-2786-7.CrossRefPubMedGoogle Scholar
  17. 17.
    Vargas MI, Becker M, Garibotto V, Heinzer S, Loubeyre P, Gariani J, et al. Approaches for the optimization of MR protocols in clinical hybrid PET/MRI studies. MAGMA. 2013;26(1):57–69.  https://doi.org/10.1007/s10334-012-0340-9.CrossRefPubMedGoogle Scholar
  18. 18.
    Steiner C, Vees H, Zaidi H, Wissmeyer M, Berrebi O, Kossovsky MP, et al. Three-phase 18F-fluorocholine PET/CT in the evaluation of prostate cancer recurrence. Nuklearmedizin Nucl Med. 2009;48(1):1–9 quiz N2-3.CrossRefGoogle Scholar
  19. 19.
    Zilli T, Jorcano S, Peguret N, Caparrotti F, Hidalgo A, Khan HG, et al. Results of dose-adapted salvage radiotherapy after radical prostatectomy based on an endorectal MRI target definition model. Am J Clin Oncol. 2017;40(2):194–9.  https://doi.org/10.1097/COC.0000000000000130.CrossRefPubMedGoogle Scholar
  20. 20.
    Tran S, Jorcano S, Falco T, Lamanna G, Miralbell R, Zilli T. Oligorecurrent nodal prostate cancer: long-term results of an elective nodal irradiation approach. Am J Clin Oncol. 2018.  https://doi.org/10.1097/coc.0000000000000419.CrossRefPubMedGoogle Scholar
  21. 21.
    Sobol I, Zaid HB, Haloi R, Mynderse LA, Froemming AT, Lowe VJ, et al. Contemporary mapping of post-prostatectomy prostate cancer relapse with (11)C-choline positron emission tomography and multiparametric magnetic resonance imaging. J Urol. 2017;197(1):129–34.  https://doi.org/10.1016/j.juro.2016.07.073.CrossRefPubMedGoogle Scholar
  22. 22.
    Panebianco V, Sciarra A, Lisi D, Galati F, Buonocore V, Catalano C, et al. Prostate cancer: 1HMRS-DCEMR at 3T versus [(18)F]choline PET/CT in the detection of local prostate cancer recurrence in men with biochemical progression after radical retropubic prostatectomy (RRP). Eur J Radiol. 2012;81(4):700–8.  https://doi.org/10.1016/j.ejrad.2011.01.095.CrossRefPubMedGoogle Scholar
  23. 23.
    Freitag MT, Radtke JP, Afshar-Oromieh A, Roethke MC, Hadaschik BA, Gleave M, et al. Local recurrence of prostate cancer after radical prostatectomy is at risk to be missed in (68)Ga-PSMA-11-PET of PET/CT and PET/MRI: comparison with mpMRI integrated in simultaneous PET/MRI. Eur J Nucl Med Mol Imaging. 2017;44(5):776–87.  https://doi.org/10.1007/s00259-016-3594-z.CrossRefPubMedGoogle Scholar
  24. 24.
    Eiber M, Rauscher I, Souvatzoglou M, Maurer T, Schwaiger M, Holzapfel K, et al. Prospective head-to-head comparison of (11)C-choline-PET/MR and (11)C-choline-PET/CT for restaging of biochemical recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2017;44(13):2179–88.  https://doi.org/10.1007/s00259-017-3797-y.CrossRefPubMedGoogle Scholar
  25. 25.
    Dirix P, van Walle L, Deckers F, Van Mieghem F, Buelens G, Meijnders P, et al. Proposal for magnetic resonance imaging-guided salvage radiotherapy for prostate cancer. Acta Oncol. 2017;56(1):27–32.  https://doi.org/10.1080/0284186X.2016.1223342.CrossRefPubMedGoogle Scholar
  26. 26.
    Liauw SL, Pitroda SP, Eggener SE, Stadler WM, Pelizzari CA, Vannier MW, et al. Evaluation of the prostate bed for local recurrence after radical prostatectomy using endorectal magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2013;85(2):378–84.  https://doi.org/10.1016/j.ijrobp.2012.05.015.CrossRefPubMedGoogle Scholar
  27. 27.
    Vargas HA, Martin-Malburet AG, Takeda T, Corradi RB, Eastham J, Wibmer A, et al. Localizing sites of disease in patients with rising serum prostate-specific antigen up to 1 ng/ml following prostatectomy: How much information can conventional imaging provide? Urol Oncol. 2016;34(11):482.  https://doi.org/10.1016/j.urolonc.2016.05.026.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Sharma V, Nehra A, Colicchia M, Westerman ME, Kawashima A, Froemming AT, et al. Multiparametric Magnetic Resonance Imaging Is an Independent Predictor of Salvage Radiotherapy Outcomes After Radical Prostatectomy. Eur Urol. 2017.  https://doi.org/10.1016/j.eururo.2017.11.012.CrossRefPubMedGoogle Scholar
  29. 29.
    Rybalov M, Breeuwsma AJ, Leliveld AM, Pruim J, Dierckx RA, de Jong IJ. Impact of total PSA, PSA doubling time and PSA velocity on detection rates of 11C-Choline positron emission tomography in recurrent prostate cancer. World J Urol. 2013;31(2):319–23.  https://doi.org/10.1007/s00345-012-0908-z.CrossRefPubMedGoogle Scholar
  30. 30.
    Fanti S, Minozzi S, Castellucci P, Balduzzi S, Herrmann K, Krause BJ, et al. PET/CT with (11)C-choline for evaluation of prostate cancer patients with biochemical recurrence: meta-analysis and critical review of available data. Eur J Nucl Med Mol Imaging. 2016;43(1):55–69.  https://doi.org/10.1007/s00259-015-3202-7.CrossRefPubMedGoogle Scholar
  31. 31.
    Kranzbuhler B, Nagel H, Becker AS, Muller J, Huellner M, Stolzmann P, et al. Clinical performance of (68)Ga-PSMA-11 PET/MRI for the detection of recurrent prostate cancer following radical prostatectomy. Eur J Nucl Med Mol Imaging. 2018;45(1):20–30.  https://doi.org/10.1007/s00259-017-3850-x.CrossRefPubMedGoogle Scholar
  32. 32.
    Padhani AR, Lecouvet FE, Tunariu N, Koh DM, De Keyzer F, Collins DJ, et al. METastasis reporting and data system for prostate cancer: practical guidelines for acquisition, interpretation, and reporting of whole-body magnetic resonance imaging-based evaluations of multiorgan involvement in advanced prostate cancer. Eur Urol. 2017;71(1):81–92.  https://doi.org/10.1016/j.eururo.2016.05.033.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Krause BJ, Souvatzoglou M, Tuncel M, Herrmann K, Buck AK, Praus C, et al. The detection rate of [11C]choline-PET/CT depends on the serum PSA-value in patients with biochemical recurrence of prostate cancer. Eur J Nucl Med Mol Imaging. 2008;35(1):18–23.  https://doi.org/10.1007/s00259-007-0581-4.CrossRefPubMedGoogle Scholar
  34. 34.
    Afshar-Oromieh A, Haberkorn U, Schlemmer HP, Fenchel M, Eder M, Eisenhut M, et al. Comparison of PET/CT and PET/MRI hybrid systems using a 68Ga-labelled PSMA ligand for the diagnosis of recurrent prostate cancer: initial experience. Eur J Nucl Med Mol Imaging. 2014;41(5):887–97.  https://doi.org/10.1007/s00259-013-2660-z.CrossRefPubMedGoogle Scholar
  35. 35.
    Freitag MT, Radtke JP, Hadaschik BA, Kopp-Schneider A, Eder M, Kopka K, et al. Comparison of hybrid (68)Ga-PSMA PET/MRI and (68)Ga-PSMA PET/CT in the evaluation of lymph node and bone metastases of prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43(1):70–83.  https://doi.org/10.1007/s00259-015-3206-3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Verane Achard
    • 1
  • Giorgio Lamanna
    • 1
  • Antoine Denis
    • 2
  • Thomas De Perrot
    • 3
  • Ismini Charis Mainta
    • 2
  • Osman Ratib
    • 2
  • Christophe Iselin
    • 4
  • Raymond Miralbell
    • 1
  • Valentina Garibotto
    • 2
  • Thomas Zilli
    • 1
    Email author
  1. 1.Radiation Oncology DivisionGeneva University HospitalGeneva 14Switzerland
  2. 2.Nuclear MedicineGeneva University HospitalGenevaSwitzerland
  3. 3.RadiologyGeneva University HospitalGenevaSwitzerland
  4. 4.UrologyGeneva University HospitalGenevaSwitzerland

Personalised recommendations