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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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.
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.
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).
Semiquantitative parameters of FCH-PET/CT play a prognostic role in mCRCP patients treated with abiraterone or enzalutamide.
KeywordsTLA FCH-PET/CT Abiraterone Enzalutamide CRPC Castration-resistant prostate cancer
The authors would like to thank Grainne Eileen Tierney for editorial assistance.
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.
Compliance with ethical standards
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.
All patients gave their written informed consent.
Conflicts of interest
The authors declare that they have no competing interests.
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