Service of Nuclear Medicine, Department of Haematology-Oncology and Laboratory Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.
Eur J Nucl Med Mol Imaging. 2011 Jan;38(1):55-63. doi: 10.1007/s00259-010-1604-0. Epub 2010 Sep 17.
PURPOSE: The aim of this study was to evaluate the potential usefulness of whole-body (11)C-choline PET/CT in the re-staging of prostate cancer (PC) patients previously treated with radical prostatectomy (RP), who presented a mild increase of prostate-specific antigen (PSA) <1.5 ng/ml (early biochemical relapse) during follow-up (FU). METHODS: We evaluated 102 consecutive patients (mean age = 68 years, range = 54-82 years) previously treated with RP and who presented during FU a mild increase of trigger PSA serum levels <1.5 ng/ml: mean 0.86 ± 0.40 ng/ml (range 0.2-1.5) and median 0.93 ng/ml (range 0.67-1.10). In this patient series (11)C-choline PET/CT was used as the first imaging examination at the time of the detection of a mild serum PSA increase <1.5 ng/ml. (11)C-Choline PET/CT was performed following standard procedures in our centre. At the time of PET/CT, 86 patients were not receiving any pharmacologic treatment, while 16 were under anti-androgenic therapy. Positive PET findings were validated by: (a) transrectal ultrasound (TRUS)-guided biopsy in cases of local recurrence, (b) surgical lymphadenectomy, (c) other imaging procedures or (d) FU lasting for at least 12 months. Univariate and multivariate analyses were used to evaluate the following variables: age, TNM staging, Gleason score, time from RP to the biochemical relapse, anti-androgen therapy at the time of (11)C-choline PET/CT scan, trigger PSA value and PSA kinetics, i.e. PSA doubling time (PSAdt) and PSA velocity (PSAvel), in order to assess the significant predictive factors related to the findings of a positive (11)C-choline PET/CT scan. RESULTS: Overall, (11)C-choline PET/CT showed positive findings in 29 of 102 patients (28% of cases). In detail, (11)C-choline PET/CT detected: local relapse in 7 patients, bone metastases in 13 patients (4 single and 9 multiple) and lymph node metastases in 9 patients (6 single and 3 multiple). Positive PET findings were validated by: (a) TRUS-guided biopsy in 7 patients with local recurrence, (b) surgery and lymphadenectomy in 3 patients, (c) other targeted imaging procedures (MR or bone scan) in 5 patients and (d) clinical FU lasting a minimum of 12 months and including also a contrast-enhanced CT (CECT), an MR, a bone scan and a repeated (11)C-choline PET/CT in 14 patients. Age, time to biochemical relapse (TTR), initial T staging, Gleason score and trigger PSA were not statistically significant in predicting a positive (11)C-choline PET/CT scan both at univariate and multivariate analysis. Instead, PSA kinetics (PSAdt and PSAvel), N status and anti-androgenic therapy at the time of PET scan were statistically significant predictive factors at univariate analysis. Of note, only PSAdt and initial N status were found to be significant and independent predictive factors at multivariate analysis. The mean PSAdt in PET-positive patients was 4.34 months (SD 2.82) while in PET-negative patients it was 13.30 months (SD 9.75) (p = 0.0001). The optimal threshold for PSAdt established by receiver-operating characteristic (ROC) analysis was 7.25 months (AUC 0.85; 95% confidence interval 0.77-0.91) providing 93% sensitivity, 74% specificity, 60% positive predictive value and 96% negative predictive value. CONCLUSION: In our study, (11)C-choline PET/CT was able to detect recurrent disease in 28% of the patients with mild biochemical relapse characterized by very low trigger PSA levels (PSA <1.5 ng/ml). Very interestingly (11)C-choline PET/CT detected distant unexpected metastases in 21% of the patients. At multivariate statistical analysis only PSAdt and node status were shown to be significant and independent predictive factors for positive (11)C-choline PET/CT. Therefore, (11)C-choline could be suggested to be performed early during initial biochemical relapse in patients presenting with fast PSA kinetics. The early detection of the site of recurrence could lead to a prompt instauration of the most appropriate treatment, i.e. local surgery or radiation treatment vs systemic treatment. In this view, one of the main advantages should be the avoidance of unnecessary local radiotherapy in those patients showing distant metastasis at (11)C-choline PET/CT.
目的：本研究旨在评估全身（11）C-胆碱 PET/CT 在先前接受根治性前列腺切除术（RP）治疗且在随访期间出现轻度前列腺特异性抗原（PSA）升高（PSA<1.5ng/ml）的前列腺癌（PC）患者中的潜在用途，这些患者的 PSA 轻度升高（PSA<1.5ng/ml）。
方法：我们评估了 102 例连续患者（平均年龄 68 岁，范围 54-82 岁），这些患者在 FU 期间出现轻度 PSA 血清水平升高，触发 PSA 血清水平<1.5ng/ml：平均 0.86±0.40ng/ml（范围 0.2-1.5）和中位数 0.93ng/ml（范围 0.67-1.10）。在这个患者系列中，（11）C-胆碱 PET/CT 作为检测轻度血清 PSA 升高（PSA<1.5ng/ml）时的第一个影像学检查。（11）C-胆碱 PET/CT 在我们中心按照标准程序进行。在 PET/CT 时，86 例患者未接受任何药物治疗，16 例患者接受抗雄激素治疗。阳性 PET 发现通过以下方式得到验证：（a）局部复发时经直肠超声（TRUS）引导活检，（b）手术淋巴结清扫，（c）其他影像学检查或（d）FU 持续至少 12 个月。使用单变量和多变量分析评估以下变量：年龄、TNM 分期、Gleason 评分、从 RP 到生化复发的时间、（11）C-胆碱 PET/CT 扫描时的抗雄激素治疗、触发 PSA 值和 PSA 动力学，即 PSA 倍增时间（PSAdt）和 PSA 速度（PSAvdl），以评估与（11）C-胆碱 PET/CT 扫描阳性发现相关的显著预测因素。
结果：总体而言，（11）C-胆碱 PET/CT 在 102 例患者中的 29 例（28%的病例）中显示出阳性结果。具体来说，（11）C-胆碱 PET/CT 检测到：7 例局部复发，13 例骨转移（1 例单发和 9 例多发）和 9 例淋巴结转移（6 例单发和 3 例多发）。阳性 PET 发现通过以下方式得到验证：（a）7 例局部复发患者经 TRUS 引导活检，（b）3 例患者手术和淋巴结清扫，（c）5 例患者进行其他靶向影像学检查（MR 或骨扫描），（d）14 例患者进行临床 FU，至少 12 个月，包括对比增强 CT（CECT）、MR、骨扫描和重复（11）C-胆碱 PET/CT。年龄、生化复发时间（TTR）、初始 T 分期、Gleason 评分和触发 PSA 在单变量和多变量分析中均不能预测（11）C-胆碱 PET/CT 扫描的阳性结果。相反，PSA 动力学（PSAdt 和 PSAvdl）、N 状态和 PET 扫描时的抗雄激素治疗是单变量分析中的统计学显著预测因素。值得注意的是，只有 PSAdt 和初始 N 状态在多变量分析中是显著和独立的预测因素。PET 阳性患者的平均 PSAdt 为 4.34 个月（SD 2.82），而 PET 阴性患者为 13.30 个月（SD 9.75）（p=0.0001）。通过接受者操作特征（ROC）分析确定的 PSAdt 最佳阈值为 7.25 个月（AUC 0.85；95%置信区间 0.77-0.91），提供 93%的敏感性、74%的特异性、60%的阳性预测值和 96%的阴性预测值。
结论：在我们的研究中，（11）C-胆碱 PET/CT 能够在触发 PSA 水平非常低（PSA<1.5ng/ml）的轻度生化复发患者中检测到复发性疾病。（11）C-胆碱 PET/CT 在 21%的患者中检测到了意想不到的远处转移。在多变量统计分析中，只有 PSAdt 和节点状态被证明是阳性（11）C-胆碱 PET/CT 的显著和独立预测因素。因此，在具有快速 PSA 动力学的患者初始生化复发期间，可以建议进行（11）C-胆碱。早期检测复发部位可以导致及时实施最合适的治疗，即局部手术或放疗与全身治疗。在这方面，主要优势之一应该是避免对那些在（11）C-胆碱 PET/CT 中显示远处转移的患者进行不必要的局部放疗。
Eur J Nucl Med Mol Imaging. 2012-11-14
Eur J Nucl Med Mol Imaging. 2014-5
Eur J Nucl Med Mol Imaging. 2010-3-20
Contrast Media Mol Imaging. 2020
Radiol Case Rep. 2019-10-1
Eur J Nucl Med Mol Imaging. 2010-3-20
Clin Oncol (R Coll Radiol). 2009-11-30
Eur J Nucl Med Mol Imaging. 2009-9-15
Eur J Nucl Med Mol Imaging. 2008-2
Eur J Nucl Med Mol Imaging. 2008-1
Eur J Nucl Med Mol Imaging. 2006-12
Zotero 插件