Abstract
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Objectives Prostate cancer is most likely to be cured if it is resectable. Optimal outcomes require selection of patients who have no extraprostatic disease. To assess 18F-FDG (FDG) and 11C-choline (CHOL) PET in men planned for radical prostatectomy to determine the accuracy of PET, effects of PET on decision making by surgeons, and correlation with PSA, MRI and TRUS biopsy and prostatectomy specimens.
Methods All men were consented and underwent TRUS-guided prostatic biopsies, CT and MRI scans, PSA and standard staging investigations. The urologist then documented the treatment plan based on these results. Patients then underwent FDG and CHOL PET, afterwhich the urologist determined whether this information altered the treatment plan. The prostatectomy specimen was reconstructed, examined histologically and correlated with the TRUS and imaging results by sextant analysis.
Results 30 patients entered and completed the trial, with results shown in the table. Neither PET modality significantly affected decisions about surgery, but CHOL PET was most sensitive & accurate, compared to pathology. Preoperative PSA did not correlate with degree of involvement. FDG PET was unhelpful.
Conclusions CHOL PET was superior to both TRUS and MRI, with greater sensitivity, accuracy and highest congruity with pathology. CHOL PET also had the highest positive predictive value, although specificity was reduced due to the prevalence of benign prostatic hypertrophy, which also showed choline uptake.
Research Support Supported by grant 487916 through Cancer Australia, Prostate Cancer Foundation Australia, Australian Government Department of Health and Aging. IDD is supported by an NHMRC Practitioner Fellowship