Ceci Francesco, Castellucci Paolo, Graziani Tiziano, Schiavina Riccardo, Renzi Riccardo, Borghesi Marco, Di Tullio Piergiorgio, Brunocilla Eugenio, Ardizzoni Andrea, Fanti Stefano
Service of Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
UO Medicina Nucleare PAD. 30, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti, 9, 40138, Bologna, Italy.
Eur J Nucl Med Mol Imaging. 2016 Jan;43(1):84-91. doi: 10.1007/s00259-015-3177-4. Epub 2015 Sep 1.
To investigate the role of (11)C-choline PET/CT for evaluating the response to treatment in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with docetaxel in comparison with PSA response.
Inclusion criteria were (a) proven mCRPC, (b) docetaxel as first line of chemotherapy (docetaxel 75 mg/m(2) + prednisone 5 mg), and (c) (11)C-choline PET/CT and PSA values assessed before and after docetaxel administration. A total of 61 patients were retrospectively enrolled (mean age 68.9 years, range 57 - 84 years). (11)C-Choline PET/CT was performed at baseline before docetaxel treatment (PET1) and after the end of treatment (PET2). PSA values were measured before treatment (PSA1) and after treatment (PSA2). PET2 was reported as complete response (CR), partial response (PR) or stable disease (SD). Progressive disease (PD) was considered if a new lesion was seen. PSA trend was calculated from the change in absolute values between PSA1 and PSA2. A decrease of ≥50 % between PSA1 and PSA2 was considered a PSA response. Clinical, radiological and laboratory follow-up ranged from 6 to 53 months (mean 13.5 months).
Of the 61 patients, 40 (65.5 %) showed PD on PET2, 13 (21.3 %) showed SD, 2 (3.4 %) showed PR, and 6 (9.8 %) showed CR. An increasing PSA trend was seen in 29 patients (47.5 %) and a decreasing PSA trend in 32 patients (52.5 %). A PSA response of ≥50 % was seen in 25 patients (41 %). Radiological PD was seen in 23 of the 29 patients (79.3 %) with an increasing PSA trend, in 16 of the 32 patients (50 %) with a decreasing PSA trend, and in 11 of the 25 patients (44 %) with a PSA response of ≥50 %. In the multivariate statistical analysis, the presence of more than ten bone lesions detected on PET1 was significantly associated with an increased probability of PD on PET2. No association was observed between PSA level and PD on PET2.
Our results suggest that an increasing PSA trend measured after docetaxel treatment could be considered predictive of PD. In patients with decreasing PSA values (decreasing PSA trend and a PSA response of ≥50 %), (11)C-choline PET/CT may be useful to identify those with radiological progression despite a PSA response. Finally, the tumour burden, expressed as number of bone lesions on PET1, is significantly associated with an increased probability of PD on PET2.
研究¹¹C-胆碱PET/CT在评估多西他赛治疗的转移性去势抵抗性前列腺癌（mCRPC）患者治疗反应中的作用，并与前列腺特异性抗原（PSA）反应进行比较。
纳入标准为：（a）确诊为mCRPC；（b）多西他赛作为一线化疗药物（多西他赛75mg/m²+泼尼松5mg）；（c）在多西他赛给药前后评估¹¹C-胆碱PET/CT和PSA值。共回顾性纳入61例患者（平均年龄68.9岁，范围57-84岁）。在多西他赛治疗前的基线期（PET1）和治疗结束后（PET2）进行¹¹C-胆碱PET/CT检查。在治疗前（PSA1）和治疗后（PSA2）测量PSA值。PET2报告为完全缓解（CR）、部分缓解（PR）或疾病稳定（SD）。如果发现新病灶，则考虑为疾病进展（PD）。根据PSA1和PSA2绝对值的变化计算PSA趋势。PSA1和PSA2之间下降≥50%被视为PSA反应。临床、影像学和实验室随访时间为6至53个月（平均13.5个月）。
61例患者中，40例（65.5%）在PET2上显示疾病进展，13例（21.3%）显示疾病稳定，2例（3.4%）显示部分缓解，6例（9.8%）显示完全缓解。29例患者（47.5%）的PSA趋势上升，32例患者（52.5%）的PSA趋势下降。25例患者（41%）的PSA反应≥50%。在PSA趋势上升的29例患者中，23例（79.3%）出现影像学疾病进展；在PSA趋势下降的32例患者中，16例（50%）出现影像学疾病进展；在PSA反应≥50%的25例患者中，11例（44%）出现影像学疾病进展。在多变量统计分析中，PET1上检测到超过10个骨病变与PET2上疾病进展的可能性增加显著相关。未观察到PSA水平与PET2上疾病进展之间的关联。
我们的结果表明，多西他赛治疗后测量的PSA趋势上升可被视为疾病进展的预测指标。在PSA值下降的患者（PSA趋势下降且PSA反应≥50%）中，¹¹C-胆碱PET/CT可能有助于识别那些尽管有PSA反应但仍有影像学进展的患者。最后，以PET1上的骨病变数量表示的肿瘤负荷与PET2上疾病进展的可能性增加显著相关。
