Gauvin Simon, Cerantola Yannick, Haberer Eléonore, Pelsser Vincent, Probst Stephan, Bladou Franck, Anidjar Maurice
Department of Radiology, Jewish General Hospital, McGill University Health Centre, Montreal, QC, Canada.
Department of Urology, Jewish General Hospital, Montreal, QC, Canada.
Can Urol Assoc J. 2017 Jan-Feb;11(1-2):47-52. doi: 10.5489/cuaj.4068.
We sought to determine predictive factors (patient and prostate-specific antigen [PSA] characteristics) for 18F-fluoromethylcholine positron emission tomography-computed tomography (18F-FCH PET/CT) positivity in the context of biochemical recurrence after local treatment of prostate cancer (PCa) with curative intent.
This is a retrospective study including 60 18F-FCH PET/CT scans of patients with biochemical recurrence after initial radical prostatectomy (RP), external beam radiation therapy (EBRT), or focal high-intensity focused ultrasound (HIFU) with curative intent. The results were compared to findings on magnetic resonance imaging (MRI), computed tomography (CT), bone scan (BS), and histological analysis when available. Univariate analysis was performed to correlate results with patient characteristics.
Thirty-eight (63.3%) scans were positive, 17 (28.3%) negative, and 5 (8.3%) equivocal. Of the positive scans, 16 demonstrated local recurrence, 12 regional/distant lymph nodes, five bone metastasis, and five local and distant recurrences. Among the 22 PET/CTs showing metastasis, conventional imaging was performed in 16 patients (72.7%). Of these, it demonstrated the lesion(s) found on PET/CT in eight patients (50.0%), was negative in seven (43.8%), and equivocal in one (6.3%). The trigger PSA (p=0.04), prostate-specific antigen velocity (PSAV) (p=0.03), and prostate-specific antigen doubling time (PSADT) (p=0.046) were significantly different when comparing positive and negative scans. Patients with positive scans were more likely to have received EBRT initially (odds ratio [OR] 11.0, 95% confidence interval [CI] 2.2-55.3). A trigger PSA of 2.6 ng/mL had a sensitivity of 84% and specificity of 65% for a positive scan. PET/CT changed the clinical management plan in 17 patients (28.3%).
18F-FCH PET/CT demonstrates a high detection rate for local and distant recurrences after localized PCa treatment. A trigger PSA above 2.6 ng/mL seems optimal for appropriate patient selection.
我们试图确定在以根治为目的的前列腺癌（PCa）局部治疗后生化复发的情况下，18F-氟甲基胆碱正电子发射断层扫描-计算机断层扫描（18F-FCH PET/CT）阳性的预测因素（患者及前列腺特异性抗原[PSA]特征）。
这是一项回顾性研究，纳入了60例经18F-FCH PET/CT扫描的患者，这些患者在初次根治性前列腺切除术（RP）、外照射放疗（EBRT）或聚焦高强度聚焦超声（HIFU）治疗后出现生化复发，且治疗目的为根治。将结果与磁共振成像（MRI）、计算机断层扫描（CT）、骨扫描（BS）以及可用时的组织学分析结果进行比较。进行单因素分析以将结果与患者特征相关联。
38例（63.3%）扫描结果为阳性，17例（28.3%）为阴性，5例（8.3%）为可疑。在阳性扫描中，16例显示局部复发，12例显示区域/远处淋巴结转移，5例显示骨转移，5例显示局部和远处复发。在22例显示转移的PET/CT检查中，16例患者（72.7%）进行了传统成像检查。其中，8例患者（50.0%）的传统成像检查显示了PET/CT检查发现的病变，7例（43.8%）为阴性，1例（6.3%）为可疑。比较阳性和阴性扫描时，触发PSA（p=0.04）、前列腺特异性抗原速度（PSAV）（p=0.03）和前列腺特异性抗原倍增时间（PSADT）（p=0.046）有显著差异。扫描结果为阳性的患者更有可能最初接受了EBRT（比值比[OR] 11.0，95%置信区间[CI] 2.2 - 55.3）。触发PSA为2.6 ng/mL时，阳性扫描的灵敏度为84%，特异性为65%。PET/CT改变了17例患者（28.3%）的临床管理计划。
18F-FCH PET/CT对局限性PCa治疗后的局部和远处复发显示出较高的检出率。触发PSA高于2.6 ng/mL似乎是进行合适患者选择的最佳标准。
