Utility of [11 C]choline PET/CT in guiding lesion-targeted salvage therapies in patients with prostate cancer recurrence localized to a single lymph node at imaging: Results from a pathologically validated series

• Published in: Urologic oncology 2014, Vol.32 (1), p.38.e9-38.e16
• Main Authors: Passoni, Niccolò M., M.D, Suardi, Nazareno, M.D, Abdollah, Firas, M.D, Picchio, Maria, M.D, Giovacchini, Giampiero, M.D, Messa, Cristina, M.D, Freschi, Massimo, M.D, Montorsi, Francesco, M.D, Briganti, Alberto, M.D
• Format: Article
• Language: English
• Subjects: Aged; Androgen Antagonists - therapeutic use; Carbon Radioisotopes; Choline; Humans; Lymph node dissection; Lymph Node Excision; Lymph Nodes - diagnostic imaging; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Middle Aged; Multimodal Imaging - methods; Neoplasm Recurrence, Local; Outcome Assessment (Health Care) - methods; Outcome Assessment (Health Care) - statistics & numerical data; PET/CT; Positron-Emission Tomography - methods; Prospective Studies; Prostate cancer; Prostate-Specific Antigen - analysis; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - therapy; Recurrence; Reproducibility of Results; Salvage Therapy; Sensitivity and Specificity; Staging; Tomography, X-Ray Computed - methods; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2013.03.006

Abstract Objective Positron emission tomography (PET)/computed tomography (CT) has been shown to be a valid tool in detecting lymph node (LN) metastases in men with biochemical recurrence after radical prostatectomy. We assessed its validity in detecting a single positive LN at pathologic examination in regard to an increasing interest in lesion-targeted salvage therapies. Methods and materials We included 46 patients with biochemical recurrence after radical prostatectomy and a single positive spot at [11 C]choline PET/CT who underwent pelvic or pelvic and retroperitoneal LN dissection. The ability of [11 C]choline PET/CT in identifying the exact positive LN was assessed with the positive predictive value (PPV) in the overall population and according to androgen deprivation therapy, prostate-specific antigen value, and site of PET/CT positivity. Results Overall, 30 patients (65%) had positive LNs at pathologic examination. Of these, only 16 (35%) had pathologically confirmed metastases in the same lymphatic region and 11 (24%) had involvement of 1 single LN. Conversely, 28 patients had positive LNs in other areas and 8 had no evidence of metastases. The overall PPV of PET/CT was 34.8% and 23.9% when exact concordance was defined according to the lymphatic landing site and single positive LN, respectively. The PPV ranged from 33.3% to 44.4% and from 17.9% to 28.6%, in men with and without androgen deprivation therapy, respectively. Conclusions The PPV [11 C]choline of PET/CT in correctly identifying patients with a single positive LN at salvage LN dissection is poor (24%). Therefore, extensive salvage treatment approaches are needed to maximize the chance of cure.