Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2010 May 1;77(1):160-4. doi: 10.1016/j.ijrobp.2009.04.090. Epub 2009 Sep 23.
An elevated serum prostate-specific antigen (PSA) level cannot distinguish between local-regional recurrences and the presence of distant metastases after treatment with curative intent for prostate cancer. With the advent of salvage treatment such as cryotherapy, it has become important to localize the site of recurrence (local or distant). In this study, the potential of (11)C-choline positron emission tomography (PET) to identify site of recurrence was investigated in patients with rising PSA after external-beam radiotherapy (EBRT).
Seventy patients with histologically proven prostate cancer treated with EBRT and showing biochemical recurrence as defined by American Society for Therapeutic Radiology and Oncology consensus statement and 10 patients without recurrence underwent a PET scan using 400 MBq (11)C-choline intravenously. Biopsy-proven histology from the site of suspicion, findings with other imaging modalities, clinical follow-up and/or response to adjuvant therapy were used as comparative references.
None of the 10 patients without biochemical recurrence had a positive PET scan. Fifty-seven of 70 patients with biochemical recurrence (median PSA 9.1 ng/mL; mean PSA 12.3 ng/mL) showed an abnormal uptake pattern (sensitivity 81%). The site of recurrence was only local in 41 of 57 patients (mean PSA 11.1 ng/mL at scan), locoregionally and/or distant in 16 of 57 patients (mean PSA 17.7 ng/mL). Overall the positive predictive value and negative predictive value for (11)C-choline PET scan were 1.0 and 0.44 respectively. Accuracy was 84%.
(11)C-choline PET scan is a sensitive technique to identify the site of recurrence in patients with PSA relapse after EBRT for prostate cancer.
在采用根治性意图治疗前列腺癌后，血清前列腺特异性抗原（PSA）水平升高不能区分局部区域复发和远处转移的存在。随着冷冻治疗等挽救性治疗的出现，定位复发部位（局部或远处）变得尤为重要。在这项研究中，我们研究了（11）C-胆碱正电子发射断层扫描（PET）在接受外照射放射治疗（EBRT）后 PSA 升高的患者中识别复发部位的潜力。
70 例经组织学证实的前列腺癌患者接受 EBRT 治疗，根据美国治疗放射肿瘤学学会共识声明定义为生化复发，并对 10 例无复发患者进行了静脉注射 400 MBq（11）C-胆碱 PET 扫描。可疑部位的活检证实的组织学、其他成像方式的发现、临床随访和/或辅助治疗的反应被用作比较参考。
无生化复发的 10 例患者 PET 扫描均为阴性。70 例生化复发患者中有 57 例（中位 PSA 9.1 ng/mL；平均 PSA 12.3 ng/mL）显示异常摄取模式（敏感性 81%）。在 57 例生化复发患者中，只有 41 例（扫描时平均 PSA 11.1 ng/mL）的复发部位为局部，16 例（扫描时平均 PSA 17.7 ng/mL）为局部区域和/或远处。总的来说，（11）C-胆碱 PET 扫描的阳性预测值和阴性预测值分别为 1.0 和 0.44。准确性为 84%。
（11）C-胆碱 PET 扫描是一种敏感的技术，可以识别接受前列腺癌 EBRT 治疗后 PSA 复发患者的复发部位。
