Evangelista Laura, Cimitan Marino, Hodolič Marina, Baseric Tanja, Fettich Jure, Borsatti Eugenio
Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Via Gattamelata, 64, 35128, Padua, Italy.
Nuclear Medicine Unit, IRCCS National Cancer Institute (CRO), Aviano, PN, Italy.
Abdom Imaging. 2015 Oct;40(8):3230-7. doi: 10.1007/s00261-015-0547-0.
To determine when 18F-choline PET/CT can truly identify local recurrence of prostate cancer.
1031 patients from 3 European centers underwent (18)F-choline PET/CT (FCH PET/CT) for recurrent disease; 131 subjects (12.7%) showed a positive FCH uptake in the prostatic gland or prostatic fossa. Median age was 72 years (range 48-87 years), and the median PSA level at the time of FCH PET/CT scan was 4.41 ng/mL (0.22-18.13 ng/mL). 45 patients (34.4%) had a Gleason score (GS) >7, and the residual subjects had a GS ≤ 7. The assessment of true or false-positive FCH PET/CT findings was made by magnetic resonance imaging (n = 34) and/or biopsy in 75/131 cases. A χ (2) test and a Z Kolmogorov-Smirnov test were used to assess the correlation between clinical variables (age, PSA, GS, type of therapy) and FCH PET/CT findings.
FCH PET/CT resulted truly positive (TP) for recurrent disease in the prostatic gland/fossa in 59/75 patients (79%) and falsely positive (FP) in 16 subjects (21%). The median value of PSA at the time of FCH PET/CT scan was higher in TP as compared to FP, although not statistically significant (4.76 vs. 3.04 ng/mL p > 0.05). Similarly, median age, GS categories, and the type of therapy were similar between the two groups (p > 0.05). However, when matching GS categories and PSA values, we found that the number of patients with TP findings were higher in the case of a PSA > 2 ng/mL, independently from the GS (ranging between 74% and 92%). Conversely, FP rate ranged between 50% and 65% in patients with a PSA ≤ 2 ng/mL, especially in the case of GS ≤ 7, whereas FP was around 25% in those with a GS >7 and PSA > 2 ng/mL.
FCH PET/CT has a limited role in evaluation of prostatic gland/fossa recurrence, due to the physiological biodistribution of the radiopharmaceutical agent. However, in 70-90% of patients with a PSA >2 ng/mL, independently from GS, a focal FCH uptake is compatible with a true local recurrence.
确定18F-胆碱PET/CT何时能够真正识别前列腺癌的局部复发。
来自3个欧洲中心的1031例患者因疾病复发接受了18F-胆碱PET/CT（FCH PET/CT）检查；131例受试者（12.7%）在前列腺或前列腺窝显示FCH摄取阳性。中位年龄为72岁（范围48 - 87岁），FCH PET/CT扫描时的中位PSA水平为4.41 ng/mL（0.22 - 18.13 ng/mL）。45例患者（34.4%）的 Gleason评分（GS）>7，其余受试者的GS≤7。在75/131例病例中，通过磁共振成像（n = 34）和/或活检对FCH PET/CT结果的真阳性或假阳性进行评估。使用χ²检验和Z柯尔莫哥洛夫-斯米尔诺夫检验来评估临床变量（年龄、PSA、GS、治疗类型）与FCH PET/CT结果之间的相关性。
FCH PET/CT在59/75例患者（79%）的前列腺/窝复发疾病中结果为真阳性（TP），16例受试者（21%）为假阳性（FP）。FCH PET/CT扫描时TP组的PSA中位值高于FP组，尽管无统计学意义（4.76 vs. 3.04 ng/mL，p>0.05）。同样，两组之间的中位年龄、GS类别和治疗类型相似（p>0.05）。然而，当匹配GS类别和PSA值时，我们发现PSA>2 ng/mL的患者中TP结果的患者数量更高，与GS无关（范围在74%至92%之间）。相反，PSA≤2 ng/mL的患者中FP率在50%至65%之间，尤其是GS≤7的情况，而GS>7且PSA>2 ng/mL的患者中FP约为25%。
由于放射性药物的生理性生物分布，FCH PET/CT在评估前列腺/窝复发方面作用有限。然而，在70 - 90% PSA>2 ng/mL的患者中，与GS无关，局灶性FCH摄取与真正的局部复发相符。
