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Research ArticleClinical Investigations

11C-Choline PET/CT Predicts Prostate Cancer–Specific Survival in Patients with Biochemical Failure During Androgen-Deprivation Therapy

Giampiero Giovacchini, Maria Picchio, Rita Garcia-Parra, Alberto Briganti, Firas Abdollah, Luigi Gianolli, Christian Schindler, Francesco Montorsi, Cristina Messa and Ferruccio Fazio
Journal of Nuclear Medicine February 2014, 55 (2) 233-241; DOI: https://doi.org/10.2967/jnumed.113.123380
Giampiero Giovacchini
1Department of Radiology, Stadtspital Triemli, Zurich, Switzerland
2Department of Radiology and Nuclear Medicine, Stadtspital Waid, Zurich, Switzerland
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Maria Picchio
3Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
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Rita Garcia-Parra
4Department of Health Sciences, Tecnomed Foundation, University of Milano-Bicocca, Milan, Italy
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Alberto Briganti
5Department of Urology, San Raffaele Scientific Institute, Milan, Italy
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Firas Abdollah
5Department of Urology, San Raffaele Scientific Institute, Milan, Italy
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Luigi Gianolli
3Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
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Christian Schindler
6Swiss Tropical and Public Health Institute, Basel, Switzerland
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Francesco Montorsi
5Department of Urology, San Raffaele Scientific Institute, Milan, Italy
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Cristina Messa
4Department of Health Sciences, Tecnomed Foundation, University of Milano-Bicocca, Milan, Italy
7Institute for Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Milan, Italy; and
8Department of Nuclear Medicine, San Gerardo Hospital, Monza, Italy
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Ferruccio Fazio
3Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
4Department of Health Sciences, Tecnomed Foundation, University of Milano-Bicocca, Milan, Italy
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Figures

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  • FIGURE 1.
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    FIGURE 1.

    Twenty-year actuarial Kaplan–Meier PCa-specific survival probability curve in whole sample. Numbers indicate patients at risk at time tn and number of PCa-specific deaths occurred between tn and tn + 2.

  • FIGURE 2.
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    FIGURE 2.

    Kaplan–Meier PCa-specific survival probability curves in patients with negative 11C-choline PET/CT and in patients with positive 11C-choline PET/CT. Numbers indicate patients at risk at time tn and number of PCa-specific deaths occurred between tn and tn + 2.

  • FIGURE 3.
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    FIGURE 3.

    Kaplan–Meier PCa-specific survival probability curves in patients with negative 11C-choline PET/CT (PET/CT−), in patients with 11C-choline PET/CT suggestive of local recurrence or lymph node disease (PET/CT+ LR/Lfn), and in patients with 11C-choline PET/CT suggestive of bone metastases (PET/CT+ bone). Numbers indicate patients at risk at time tn and number of PCa-specific deaths occurred between tn and tn + 2.

  • FIGURE 4.
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    FIGURE 4.

    Nomogram (A) and calibration factor (B) predicting 10-y PCa-specific survival probability (calculated from radical prostatectomy). Perfect prediction would correspond to diagonal 45° broken line. Dotted line indicates actual nomogram performance. Expected performance on future data is represented through solid line.

  • FIGURE 5.
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    FIGURE 5.

    Nomogram (A) and calibration factor (B) predicting 15-y PCa-specific survival probability (calculated from radical prostatectomy).

  • FIGURE 6.
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    FIGURE 6.

    Nomogram (A) and calibration factor (B) predicting 5-y PCa-specific survival probability (calculated from 11C-choline PET/CT).

Tables

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    TABLE 1

    Clinical and Pathologic Characteristics of Whole Sample

    ParameterWhole sample (n = 195)PET/CT negative (n = 83)PET/CT positive (n = 112)P
    Interval prostatectomy—11C-choline PET/CT (y)0.350
     Mean ± SD4.8 ± 3.04.5 ± 2.74.9 ± 3.2
     Median4.24.24.1
     Range0.4–14.40.4–12.40.7–14.4
    Age (y)0.864
     Mean ± SD68 ± 768 ± 668 ± 7
     Median686867
     Range50–8550–7951–85
    PSA (ng/mL)<0.001
     Mean ± SD5.17 ± 8.452.60 ± 5.397.08 ± 9.73
     Median1.821.013.03
     Range0.22–48.60.22–35.00.25–48.6
    PSADT (mo) (n = 76)0.003
     Mean ± SD6.67 ± 4.829.04 ± 5.685.23 ± 3.58
     Median5.477.894.79
     Range1.11–23.591.13–23.591.11–18.37
    Pathologic stage<0.001
     pT2pN062 (32)41 (49)21 (19)
     pT3pN0 and pT4pN082 (42)28 (34)54 (48)
     Any T pN151 (26)14 (17)37 (33)
    Gleason score0.411
     <740 (20)20 (24)20 (18)
     785 (44)37 (45)48 (43)
     >770 (36)26 (31)44 (39)
    • Data in parentheses are percentages.

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    TABLE 2

    PCa-Specific Survival Probabilities (%)

    Survival (y)PET/CT negative (n = 83)PET/CT positive (n = 112)
    597.5% (95.8%–99.2%)81.8% (78.1%–85.5%)
    1080.9% (76.0%–85.8%)55.0% (49.6%–60.4%)
    1553.7% (41.6%–65.8%)17.8% (11.5%–24.1%)
    • Data in parentheses are 95% CI.

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    TABLE 3

    Cox Regression Analysis of Factors Predicting PCa-Specific Survival in Whole Sample (n = 195)

    Univariate analysisMultivariate analysis
    ParameterHRPHRP
    11C-choline PET/CT3.02 (1.80–5.08)<0.0012.53 (1.41–4.53)0.002
    Age (y)1.00 (0.97–1.04)0.7381.01 (0.98–1.05)0.469
    PSA (ng/mL)1.04 (1.02–1.06)0.0011.03 (1.00–1.05)0.037
    Pathologic stage0.0070.065
     pT2pN01 (reference)1 (reference)
     pT3pN0 and pT4pN01.24 (0.70–2.17)0.4580.79 (0.42–1.46)0.453
     Any T pN12.33 (1.32–4.09)0.0031.48 (0.82–2.69)0.191
    Gleason score0.0010.025
     <71 (reference)1 (reference)
     71.81 (0.95–3.45)0.0691.57 (0.81–3.04)0.176
     >73.26 (1.68–6.35)<0.0012.49 (1.25–4.95)0.009
    Additional therapy1.83 (1.17–2.86)0.0081.20 (0.73–1.97)0.451
    • Data in parentheses are 95% CI.

    • View popup
    TABLE 4

    Cox Regression Analysis of Factors Predicting PCa-Specific Survival in Patients with PSADT (n = 76)

    Univariate analysisBivariate analysis
    ParameterHRPHRP
    11C-choline PET/CT3.83 (1.48–9.92)0.0062.75 (1.04–7.32)0.042
    PSADT (mo)0.86 (0.77–0.95)0.0040.88 (0.79–0.98)0.029
    • Data in parentheses are 95% CI.

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    TABLE 5

    PCa-Specific Survival Probabilities (%) in Patients With Pathologic 11C-Choline Uptake and in Patients Without (M0) and With (M1) Distant Metastases

    PET/CT positive
    Survival (y)Prostatic bed/lymph nodes (n = 63)*Skeleton (n = 49)M0, prostatic bed/pelvic lymph nodes (n = 46)†M1, retroperitoneal lymph nodes/skeleton (n = 66)†
    592.6% (89.3%–95.9%)65.9% (59.0%–72.8%)97.8% (95.6%–1.00%)69.6% (63.9%–75.3%)
    1061.2% (54.1%–68.3%)47.1% (39.0%–55.2%)75.5% (68.1%–82.9%)55.0% (47.9%–62.1%)
    1520.4% (10.2%–30.6%)5.6% (0.3%–10.9%)25.0% (12.5%–37.5%)4.7% (0.2%–9.2%)
    • ↵* Without bone involvement.

    • ↵† 11C-choline PET/CT according to American Joint Committee on Cancer staging system.

    • Data in parentheses are 95% CI.

    • View popup
    TABLE 6

    Cox Regression Analysis of Factors Predicting PCa-Specific Survival (Calculated from Time of 11C-Choline PET/CT) in Whole Sample (n = 195)

    Univariate analysisMultivariate analysis
    ParameterHRPHRP
    11C-choline PET/CT4.03 (2.37–6.87)<0.0013.16 (1.72–5.78)<0.001
    Age (y)1.04 (1.00–1.07)0.0451.06 (1.02–1.10)0.002
    PSA (ng/mL)1.05 (1.02–1.07)<0.0011.05 (1.02–1.07)<0.001
    Pathologic stage0.0050.017
     pT2pN01 (reference)1 (reference)
     pT3pN0 and pT4pN01.22 (0.69–2.14)0.4850.89 (0.49–1.64)0.727
     Any T pN12.38 (1.35–4.19)0.0031.85 (1.02–3.38)0.043
    Gleason score0.2760.610
     <71 (reference)1 (reference)
     71.29 (0.69–2.42)0.4151.11 (0.58–2.12)0.732
     >71.65 (0.87–3.11)0.1191.35 (0.70–2.60)0.366
    Additional therapy2.01 (1.28–3.15)0.0021.15 (0.69–1.91)0.576
    • Data in parentheses are 95% CI.

    • View popup
    TABLE 7

    Cox Regression Analysis of Factors Predicting PCa-Specific Survival (Calculated from Time of 11C-Choline PET/CT) in Patients with PSADT (n = 76)

    Univariate analysisBivariate analysis
    ParameterHRPHRP
    11C-choline PET/CT5.61 (2.16–14.53)<0.0014.51 (1.68–12.11)0.003
    PSADT (mo)0.88 (0.80–0.97)0.0120.93 (0.84–1.03)0.178
    • Data in parentheses are 95% CI.

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Journal of Nuclear Medicine: 55 (2)
Journal of Nuclear Medicine
Vol. 55, Issue 2
February 1, 2014
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11C-Choline PET/CT Predicts Prostate Cancer–Specific Survival in Patients with Biochemical Failure During Androgen-Deprivation Therapy
Giampiero Giovacchini, Maria Picchio, Rita Garcia-Parra, Alberto Briganti, Firas Abdollah, Luigi Gianolli, Christian Schindler, Francesco Montorsi, Cristina Messa, Ferruccio Fazio
Journal of Nuclear Medicine Feb 2014, 55 (2) 233-241; DOI: 10.2967/jnumed.113.123380

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11C-Choline PET/CT Predicts Prostate Cancer–Specific Survival in Patients with Biochemical Failure During Androgen-Deprivation Therapy
Giampiero Giovacchini, Maria Picchio, Rita Garcia-Parra, Alberto Briganti, Firas Abdollah, Luigi Gianolli, Christian Schindler, Francesco Montorsi, Cristina Messa, Ferruccio Fazio
Journal of Nuclear Medicine Feb 2014, 55 (2) 233-241; DOI: 10.2967/jnumed.113.123380
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