Vees Hansjörg, Buchegger Franz, Albrecht Susanne, Khan Haleem, Husarik Daniela, Zaidi Habib, Soloviev Dmitri, Hany Thomas F, Miralbell Raymond
Service of Radiation Oncology, University Hospital, Geneva, Switzerland.
BJU Int. 2007 Jun;99(6):1415-20. doi: 10.1111/j.1464-410X.2007.06772.x. Epub 2007 Apr 8.
To assess the value of positron emission tomography (PET)/computed tomography (CT) with either (18)F-choline and/or (11)C-acetate, of residual or recurrent tumour after radical prostatectomy (RP) in patients with a prostate-specific antigen (PSA) level of <1 ng/mL and referred for adjuvant or salvage radiotherapy.
In all, 22 PET/CT studies were performed, 11 with (18)F-choline (group A) and 11 with (11)C-acetate (group B), in 20 consecutive patients (two undergoing PET/CT scans with both tracers). The median (range) PSA level before PET/CT was 0.33 (0.08-0.76) ng/mL. Endorectal-coil magnetic resonance imaging (MRI) was used in 18 patients. Nineteen patients were eligible for evaluation of biochemical response after salvage radiotherapy.
There was abnormal local tracer uptake in five and six patients in group A and B, respectively. Except for a single positive obturator lymph node, there was no other site of metastasis. In the two patients evaluated with both tracers there was no pathological uptake. Endorectal MRI was locally positive in 15 of 18 patients; 12 of 19 responded with a marked decrease in PSA level (half or more from baseline) 6 months after salvage radiotherapy.
Although (18)F-choline and (11)C-acetate PET/CT studies succeeded in detecting local residual or recurrent disease in about half the patients with PSA levels of <1 ng/mL after RP, these studies cannot yet be recommended as a standard diagnostic tool for early relapse or suspicion of subclinical minimally persistent disease after surgery. Endorectal MRI might be more helpful, especially in patients with a low likelihood of distant metastases. Nevertheless, further research with (18)F-choline and/or (11)C-acetate PET with optimal spatial resolution might be needed for patients with a high risk of distant relapse after RP even at low PSA values.
评估正电子发射断层扫描（PET）/计算机断层扫描（CT）联合（18）F - 胆碱和/或（11）C - 醋酸盐，对前列腺特异性抗原（PSA）水平<1 ng/mL且接受辅助或挽救性放疗的前列腺癌根治术（RP）后残留或复发性肿瘤的评估价值。
共对20例连续患者（其中2例接受两种示踪剂的PET/CT扫描）进行了22次PET/CT检查，11例使用（18）F - 胆碱（A组），11例使用（11）C - 醋酸盐（B组）。PET/CT检查前PSA水平的中位数（范围）为0.33（0.08 - 0.76）ng/mL。18例患者使用了直肠内线圈磁共振成像（MRI）。19例患者符合挽救性放疗后生化反应评估标准。
A组和B组分别有5例和6例患者出现局部示踪剂摄取异常。除单个闭孔淋巴结阳性外，无其他转移部位。在2例接受两种示踪剂评估的患者中，未发现病理性摄取。18例患者中15例直肠内MRI显示局部阳性；19例患者中有12例在挽救性放疗6个月后PSA水平显著下降（较基线降低一半或更多）。
尽管（18）F - 胆碱和（11）C - 醋酸盐PET/CT检查成功检测出约一半RP后PSA水平<1 ng/mL患者的局部残留或复发性疾病，但这些检查目前尚不能作为术后早期复发或怀疑亚临床微小持续性疾病的标准诊断工具推荐。直肠内MRI可能更有帮助，尤其是对于远处转移可能性低的患者。然而，对于RP后远处复发风险高甚至PSA值低的患者，可能需要进一步开展具有最佳空间分辨率的（18）F - 胆碱和/或（11）C - 醋酸盐PET研究。
