Baseline 18F-Fluorocholine PET/CT and bone scan in the outcome prediction of patients treated with radium 223 dichloride
To establish the utility of baseline 18F-Fluorocholine (FCH) PET/CT and bone scintigraphy (BS) in the outcome prediction of patients with castration-resistant prostate cancer and bone metastases (CRPC-BM) treated with 223Ra.
Prospective, multicenter and non-randomized study (ChoPET-Rad study). FCH PET/CT and BS were performed before the initiation of 223Ra (basal FCH PET/CT and BS). Bone disease was classified attending the number of lesions in baseline BS and PET/CT. FCH PET/CT was semiquantitatively evaluated. Gleason score, baseline levels of prostate-specific antigen (PSA), alkaline phosphatase and lactate dehydrogenase were determined. Progression-free survival (PFS) and overall survival (OS) since the onset of 223Ra treatment was calculated. PFS was defined by PSA rising. Relations between clinical and imaging variables with PFS and OS were evaluated by Pearson, Mann–Whitney tests and Kapplan–Meier analysis. Univariate and multivariate Cox regression analysis was performed.
Forty patients were evaluated. The median PFS and OS were of 3.0 ± 2.3 and 23.0 ± 4.2 months, respectively. 33 patients progressed and 13 died during the follow-up. The extension of the bone disease by FCH PET/CT (p = 0.011, χ2 = 10.63), BS (p = 0.044, χ2 = 8.04), SUVmax (p = 0.012) and average SUVmax (p = 0.014) were related to OS. No significant association was found for the PFS. ROC analysis revealed significant association of SUVmax, average SUVmax and basal PSA with OS. Only therapeutic failure was associated with OS in the multivariate analysis (HR = 3.6, p = 0.04).
FCH PET/CT and BS had prognostic aim in the prediction of OS. None clinical or imaging variable was able to predict the PFS, probably due to the high rate of progressive disease.
Keywords18F-Fluorocholine PET/CT Metastatic prostate cancer Bone scintigraphy 223Radium treatment Prognosis
Compliance with ethical standards
Conflict of interest
Authors declare that they have no conflict of interest.
Animal and human participant rights
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.
Informed consent was obtained from all individual participants included in the study.
- 8.Rodado Marina S, Coronado Poggio M, Garcia Vicente AM, García-Garzón JR, Alonso-Farto JC, de la Jara AC, et al. Clinical utility of 18F-fluorocholine PET-CT in biochemical relapse of prostate cancer after radical treatment: results of a multicentre study. BJU Int. 2015;115:874–83.CrossRefGoogle Scholar
- 13.Scher HI, Halabi S, Tannock I, Morris M, Sternberg CN, Carducci MA, et al. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol. 2008;26:1148–59.CrossRefGoogle Scholar
- 20.Mottet N, Bellmunt J, Briers E, Van den Bergh RCN, Bolla M, Van Casteren NJ, et al. Guidelines on prostate cancer. European Association of Urology. 2015. https://uroweb.org/wp-content/…/07-Prostate-Cancer_LR.pdf. Accessed Mar 2015.
- 25.Murray I, Chittenden SJ, Denis-Bacelar AM, Hindorf C, Parker CC, Chua S, et al. The potential of Ra and F-fluoride imaging to predict bone lesion response to treatment with 223Ra-dichloride in castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging. 2017. https://doi.org/10.1007/s00259-017-3744-y.Google Scholar
- 30.Nakajima K, Nakajima Y, Horikoshi H, Ueno M, Wakabayashi H, Shiga T, et al. Enhanced diagnostic accuracy for quantitative bone scan using an artificial neural network system: a Japanese multi-center database project. Eur J Nucl Med Mol Imaging Res. 2013;3:83.Google Scholar