Department of Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili 1, Brescia 25123, Italy.
Jpn J Radiol. 2011 Jul;29(6):394-404. doi: 10.1007/s11604-011-0570-1. Epub 2011 Jul 24.
The aim of this study was to evaluate the accuracy of (11)C-choline positron emission tomography/computed tomography (PET/CT) in restaging patients affected by prostate cancer and suspected relapse due to prostate-specific antigen (PSA) increase. We also aimed to determine a PSA cutoff that is most suited to the study in terms of best compromise between sensitivity and specificity. Secondary endpoints were a comparison between (11)C-choline PET/CT and histological results, clinical findings, and radiological imaging (CT and magnetic resonance imaging).
We retrospectively evaluated 210 patients (median ± SD age 70 ± 7 years) affected by prostate cancer who underwent (11)C-choline PET/CT.
(11)C-choline PET/CT imaging was positive in 116 (55.2%) patients and negative in 94 (44.8%). Receiver operating characteristic (ROC) analysis showed that the highest accuracy (sensitivity 76.8%, specificity 92.5%) for the whole population was achieved when the PSA level of 1.26 ng/ml level was used as the cutoff value for interpreting the results (P = 0.0001 and the area under the ROC curve AUC 0.897). For patients treated with surgery or surgery plus radiotherapy the cutoff was 0.81 ng/ml (sensitivity 73.2%, specificity 86.1%). For patients treated with radiotherapy alone, the cutoff was 2.0 ng/ml (sensitivity 81.8%, specificity 92.9%).
Our results indicate that (11)C-choline PET/CT is a useful diagnostic tool in patients affected by prostate cancer and a relapsed PSA level. The highest accuracy for all patients is obtained with a PSA cutoff level of 1.26 ng/ml, above which the imaging study is performed (0.81 ng/ml for patients treated with surgery or surgery plus radiotherapy and 2.0 ng/ml for patients treated with radiotherapy alone).
本研究旨在评估（11）C-胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）在因前列腺特异性抗原（PSA）升高而怀疑复发的前列腺癌患者中的准确性。我们还旨在确定最适合研究的 PSA 截止值，以在敏感性和特异性之间取得最佳平衡。次要终点是（11）C-胆碱 PET/CT 与组织学结果、临床发现和影像学（CT 和磁共振成像）之间的比较。
我们回顾性评估了 210 名（中位年龄±标准差为 70±7 岁）患有前列腺癌的患者，他们接受了（11）C-胆碱 PET/CT 检查。
（11）C-胆碱 PET/CT 成像在 116 名（55.2%）患者中为阳性，在 94 名（44.8%）患者中为阴性。接收器操作特征（ROC）分析显示，当 PSA 水平为 1.26ng/ml 时，整个人群的准确性最高（敏感性为 76.8%，特异性为 92.5%），作为解释结果的截止值（P=0.0001，ROC 曲线下面积 AUC 为 0.897）。对于接受手术或手术加放疗的患者，截止值为 0.81ng/ml（敏感性为 73.2%，特异性为 86.1%）。对于仅接受放疗的患者，截止值为 2.0ng/ml（敏感性为 81.8%，特异性为 92.9%）。
我们的结果表明，（11）C-胆碱 PET/CT 是一种在患有前列腺癌和 PSA 水平升高的患者中有用的诊断工具。对于所有患者，PSA 截止值为 1.26ng/ml 时可获得最高的准确性，高于该值进行影像学检查（对于接受手术或手术加放疗的患者为 0.81ng/ml，对于仅接受放疗的患者为 2.0ng/ml）。
