Center for Molecular Bioimaging, University of Milano-Bicocca, Milan, Italy.
J Urol. 2010 Sep;184(3):938-43. doi: 10.1016/j.juro.2010.04.084.
We assessed the value of [11C]choline positron emission tomography/computerized tomography in patients with prostate cancer in whom biochemical failure developed after radical prostatectomy but who showed no disease evidence on conventional imaging.
Considered for this study were 2,124 patients treated with radical prostatectomy who underwent [11C]choline positron emission tomography/computerized tomography to restage disease between December 2004 and January 2007. Study inclusion criteria were 1) previous radical prostatectomy and pelvic lymph node dissection, 2) increasing prostate specific antigen beyond 0.2 ng/ml after radical prostatectomy, 3) no lymph node disease at radical prostatectomy, 4) no evidence of metastatic disease on conventional imaging, 5) no androgen deprivation therapy and 6) no adjuvant or salvage radiotherapy. These criteria were satisfied in 109 of the 2,124 patients (5%).
Median prostate specific antigen at imaging was 0.81 ng/ml (range 0.22 to 16.76 ml). Imaging suggested local recurrence in 4 patients (4%) and pelvic lymph node disease in 8 (7%). Scans were positive in 5%, 15% and 28% of patients with prostate specific antigen less than 1, between 1 and 2, and greater than 2 ng/ml, respectively (p <0.05). Prostate specific antigen was the only significant predictor of tomography results (p <0.05).
Positron emission tomography/computerized tomography detected increased [11C]choline uptake, suggesting recurrent disease in 11% of patients with prostate cancer, increasing prostate specific antigen after radical prostatectomy and no evidence of disease on conventional imaging. This modality may be useful to restage disease but it cannot be used to guide therapy.
我们评估了[11C]胆碱正电子发射断层扫描/计算机断层扫描在根治性前列腺切除术后生化复发但常规影像学检查无疾病证据的前列腺癌患者中的价值。
本研究纳入了 2124 例接受根治性前列腺切除术的患者，他们在 2004 年 12 月至 2007 年 1 月期间接受了[11C]胆碱正电子发射断层扫描/计算机断层扫描以重新分期疾病。研究纳入标准为：1）先前接受根治性前列腺切除术和盆腔淋巴结清扫术；2）根治性前列腺切除术后前列腺特异抗原（PSA）升高至 0.2ng/ml 以上；3）根治性前列腺切除术时无淋巴结疾病；4）常规影像学检查无转移性疾病证据；5）无雄激素剥夺治疗；6）无辅助或挽救性放疗。这 2124 例患者中有 109 例（5%）符合这些标准。
影像学检查时 PSA 中位数为 0.81ng/ml（范围 0.22-16.76ng/ml）。4 例（4%）患者影像学提示局部复发，8 例（7%）患者影像学提示盆腔淋巴结疾病。PSA<1ng/ml、1-2ng/ml 和>2ng/ml 的患者中，分别有 5%、15%和 28%的患者扫描阳性（p<0.05）。PSA 是唯一显著预测正电子发射断层扫描/计算机断层扫描结果的因素（p<0.05）。
正电子发射断层扫描/计算机断层扫描检测到[11C]胆碱摄取增加，提示根治性前列腺切除术后 PSA 升高且常规影像学检查无疾病证据的前列腺癌患者中有 11%发生复发性疾病。这种方法可能有助于重新分期疾病，但不能用于指导治疗。
