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First published online August 18, 2009, 10.2967/jnumed.108.061507
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Journal of Nuclear Medicine Vol. 50 No. 9 1394-1400
© 2009 by Society of Nuclear Medicine
doi: 10.2967/jnumed.108.061507

Clinical Investigation

Influence of Trigger PSA and PSA Kinetics on 11C-Choline PET/CT Detection Rate in Patients with Biochemical Relapse After Radical Prostatectomy

Paolo Castellucci1, Chiara Fuccio1, Cristina Nanni1, Ivan Santi1, Anna Rizzello1, Filippo Lodi1, Alessandro Franceschelli2, Giuseppe Martorana2, Fabio Manferrari2 and Stefano Fanti1

1 Nuclear Medicine Unit, Hematology–Oncology and Laboratory Medicine Department, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy; and 2 Urology Unit, Specialist Surgery and Anaesthesiology Department, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy

Correspondence: For correspondence or reprints contact: Paolo Castellucci, UO di Medicina Nucleare, PAD. 30, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. E-mail: paolo.castellucci{at}aosp.bo.it

The purpose of this study was to investigate the effect of total prostate-specific antigen (PSA) at the time of 11C-choline PET/CT (trigger PSA), PSA velocity (PSAvel), and PSA doubling time (PSAdt) on 11C-choline PET/CT detection rate in patients treated with radical prostatectomy for prostate cancer, who showed biochemical failure during follow-up. Methods: A total of 190 patients treated with radical prostatectomy for prostate cancer who showed an increase in PSA (mean, 4.2; median, 2.1; range, 0.2–25.4 ng/mL) were retrospectively enrolled. All patients were studied with 11C-choline PET/CT. Patients were grouped according to trigger PSA (PSA ≤ 1 ng/mL, 1 < PSA ≤ 2 ng/mL, 2 < PSA ≤ 5 ng/mL, and PSA > 5 ng/mL). In 106 patients, data were available for calculation of PSAvel and PSAdt. Logistic regression analysis was used to determine whether there was a relationship between PSA levels and PSA kinetics and the rate of detection of relapse using PET. Results: 11C-choline PET/CT detected disease relapse in 74 of 190 patients (38.9%). The detection rate of 11C-choline PET/CT was 19%, 25%, 41%, and 67% in the 4 subgroups—PSA ≤ 1 ng/mL (51 patients), 1 < PSA ≤ 2 ng/mL (39 patients), 2 < PSA ≤ 5 ng/mL (51 patients), and PSA > 5 ng/mL (49 patients)—respectively. Trigger PSA values were statistically different between PET-positive patients (median PSA, 4.0 ng/mL) and PET-negative patients (median PSA, 1.4 ng/mL) (P = 0.0001). Receiver-operating-characteristic analysis showed an optimal cutoff point for trigger PSA of 2.43 ng/mL (area under the curve, 0.76). In 106 patients, PSAdt and PSAvel values were statistically different between patients with PET-positive and -negative scan findings (P = 0.04 and P = 0.03). The 11C-choline PET/CT detection rate was 12%, 34%, 42%, and 70%, respectively, in patients with PSAvel < 1 ng/mL/y (33 patients), 1 < PSAvel ≤ 2 ng/mL/y (26 patients), 2 < PSAvel ≤ 5 ng/mL/y (19 patients), and PSAvel > 5 ng/mL/y (28 patients). The 11C-choline PET/CT detection rate was 20%, 40%, 48%, and 60%, respectively, in patients with PSAdt > 6 mo (45 patients), 4 < PSAdt ≤ 6 mo (20 patients), 2 < PSAdt ≤ 4 mo (31 patients), and PSAdt ≤ 2 mo (10 patients). There was no statistical difference between PET-positive and -negative scan detection rates according to the Gleason score, pT and N status, patient age, or duration between surgery and biochemical relapse. Trigger PSA and PSAvel were found to be independent predictive factors for a PET-positive result (P = 0.002; P = 0.04) and PSAdt was found to be an independent factor only in patients with trigger PSA less than 2 ng/mL (P = 0.05) using multivariate analysis. Conclusion: The 11C-choline PET/CT detection rate is influenced by trigger PSA, PSAdt, and PSAvel. This finding could be used to improve the selection of patients for scanning by reducing the number of false-negative scans and increasing the detection rate of disease in patients with early relapse and potentially curative disease.

Key Words: prostate cancer • positron emission tomography (PET) • choline • PSA • PSA kinetics

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.


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