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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy

    Giampiero Giovacchini, Elisabetta Giovannini, Mattia Riondato & Andrea Ciarmiello

  2. University of Milan-Bicocca, Milan, Italy

    Priscilla Guglielmo

  3. Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Priscilla Guglielmo, Paola Mapelli, Elena Incerti, Ana Maria Samanes Gajate, Luigi Gianolli & Maria Picchio

  4. Vita-Salute San Raffaele University, Milan, Italy

    Paola Mapelli, Alberto Briganti & Maria Picchio

  5. Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Alberto Briganti

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  1. Giampiero Giovacchini
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  2. Priscilla Guglielmo
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  3. Paola Mapelli
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Correspondence to Maria Picchio.

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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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Giovacchini, G., Guglielmo, P., Mapelli, P. et al. 11C-choline PET/CT predicts survival in prostate cancer patients with PSA < 1 NG/ml. Eur J Nucl Med Mol Imaging 46, 921–929 (2019). https://doi.org/10.1007/s00259-018-4253-3

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  • DOI: https://doi.org/10.1007/s00259-018-4253-3

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