Research ArticleCLINICAL INVESTIGATIONS

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

Paolo Castellucci, Chiara Fuccio, Cristina Nanni, Ivan Santi, Anna Rizzello, Filippo Lodi, Alessandro Franceschelli, Giuseppe Martorana, Fabio Manferrari and Stefano Fanti
Journal of Nuclear Medicine September 2009, 50 (9) 1394-1400; DOI: https://doi.org/10.2967/jnumed.108.061507

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Trigger PSA and PET detection rate. Detection rate of 11C-choline PET/CT in 190 patients divided in 4 subgroups on basis of trigger PSA levels at time of PET scan: 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).

  • FIGURE 2. 
    FIGURE 2. 

    ROC curve of trigger PSA values in 190 patients; optimal cutoff point, 2.43 ng/mL. Area under ROC curve (AUC) = 0.76; SE = 0.037; 95% confidence interval = 0.693–0.816.

  • FIGURE 3. 
    FIGURE 3. 

    PSAvel and PET detection rate. Detection rate of 11C-choline PET/CT in 4 groups of PSAvel values: 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).

  • FIGURE 4. 
    FIGURE 4. 

    PSAdt and PET detection rate. Detection rate of 11C-choline PET/CT in 4 groups of PSAdt values: PSAdt > 6 mo (45 patients), 4 < PSAdt ≤ 6 mo (20 patients), 2 < PSAdt ≤ 4 mo (31 patients), and PSAdt ≤ 2 mo (10 patients).

  • FIGURE 5. 
    FIGURE 5. 

    One-year-old patient who underwent surgery (initial staging, pT3b Nx, Mx; Gs 4 + 3) in July 2006. Trigger PSA at time of PET scan was 0.35 ng/mL (February 2007). (A) Maximum-intensity projection. (B) Sacral bone lesion (note large extent and high uptake of lesion [SUVmax, 7.1] without any structural damage on attenuation correction CT, suggestive of fast growing, highly hypermetabolic disease). (C) Positive paraaortic LN (9 mm). (D) Small left pelvic bone hypermetabolic lesion without corresponding findings on CT. PSAdt = 1 mo.

Tables

  • TABLE 1

    Patient Population Characteristics

    Characteristicn
    No. of patients190
    Age (y)Mean, 68 (range, 54–83)
    Gleason scoreMedian, 7 (range, 3–9)
    TNM stage
     T2N0/NxM078 patients
     T2N1M010 patients
     T3N0/NxM079 patients
     T3N1M016 patients
     T4N0M04 patients
     T4N1M03 patients
    PSA (ng/mL)Mean, 4.2 (range, 0.2–25.4)
    Median, 2.1
    Interval: radical prostatectomy–11C-choline PET/CT (mo)Mean, 46 (range, 2–120)
    Median, 36 (range, 2–120)
  • TABLE 2

    Trigger PSA and PSA Kinetics

    MeanMedianSD
    PSA typePET-positivePET-negativePET-positivePET-negativePET-positivePET-negativeP
    Trigger PSA (ng/mL) (190 patients)6.72.44.21.56.13.30.0001
    PSAvel (ng/mL/y) (106 patients)9.03.23.41.011.06.60.03
    PSAdt (mo) (106 patients)6.210.13.96.26.010.00.04
    PSAdt (mo) (60 patients)*5.011.55.07.33.011.00.05

    • ↵* PSAdt for 60 patients with trigger PSA less than 2 ng/mL.

  • TABLE 3

    PET/CT Detection Rate for Cutoffs Determined by ROC Curve Analysis

    PSAdt cutoffPSAvel cutoff
    Group>3.4 mo≤3.4 mo<1.1 ng/mL/y≥1.1 ng/mL/y
    All patients with PSAdt and PSAvel data (n = 106)22/72 (31%)19/34 (56%)5/39 (13%)36/67 (54%)
    Patients with PSAdt and PSAvel data and low trigger PSA (<2 ng/mL) (n = 60)8/43 (19%)7/17 (41%)

    • Data are number of patients with positive PET/CT findings divided by total number of patients falling within cutoff range.

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