C11-choline PET scan for prostate cancer patients with biochemical recurrence

Objectives Relapsing disease is a common and challenging form of prostate cancer encountered in the contemporary clinical setting. Distinguishing between localized cancer or systemic recurrence represents a important step in optimizing prostate cancer treatment. Therefore we sought to determine the performance of C11-choline for its ability to delineate prostate cancer distribution and extent after failed definitive therapy.

Methods Retrospective review of all prostate cancer patients who underwent evaluation using C11-choline PET/CT scan from 9/2007 to 11/2010 at the Mayo Clinic was performed. Statistical analysis was performed to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results During the study interval, a total of 254 PET scans were performed on 231 patients. 196 scans were performed on patients with biochemical recurrence after primary treatment failure. In this setting C11-choline PET scanning yielded a sensitivity, specificity, PPV, and NPV of 93, 76, 89, and 82%, respectively. 61 of 196 (31%) PET scans performed were deemed clinically “useful” as defined by their ability to detect treatable lesions, not identified using conventional imaging, thereby triggering changes in clinical management. 35 patients ultimately underwent surgical resection of isolated recurrent lesions detected by C11-choline PET. In these patients the sensitivity and PPV of C11-choline PET was 88 and 94%, respectively.

Conclusions The operational performance of C11-choline PET for the evaluation of patients with recurrent prostate cancer supports the favorable claims regarding this technology reported in the literature to date. In addition, we find that C11-choline PET substantially enhances the rate of prostate cancer lesion detection by approximately 30% beyond what can be garnered using conventionally accepted imaging technologies