Early Biochemical Relapse After Radical Prostatectomy: Which Prostate Cancer Patients May Benefit from a Restaging 11C-Choline PET/CT Scan Before Salvage Radiation Therapy?

Paolo Castellucci; Francesco Ceci; Tiziano Graziani; Riccardo Schiavina; Eugenio Brunocilla; Renzo Mazzarotto; Cinzia Pettinato; Monica Celli; Filippo Lodi; Stefano Fanti

doi:10.2967/jnumed.114.138313

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FIGURE 1.
A 68-y-old patient treated with RP for PCa (T3aN0M0; GS = 4 + 4). PSA = 0.85 ng/mL, PSAdt = 7.4 mo, PSAvel = 0.94 ng/mL/y. ¹¹C-choline PET/CT showed a positive finding in prostate bed, later confirmed at histologic analysis. (A) CT image. (B) PET image. (C) Fusion image.
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FIGURE 2.
A 76-y-old patient treated with RP for PCa (T2bN0M0; GS = 4 + 3). PSA = 1.95 ng/mL, PSAdt = 4.8 mo, PSAvel = 1.6 ng/mL/y. Patient was scheduled for S-RT. ¹¹C-choline PET/CT performed before S-RT (Fig. 1A) showed pathologic choline uptake in common subcentimetric right iliac LN (CT [A], PET [B], and fusion [C] images) and small solitary bone lesion on left ischium (CT [D], PET [E], and fusion [F] images).
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FIGURE 3.
¹¹C-choline PET/CT detection rate in different patient subpopulations.

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TABLE 1

Population Characteristics

Characteristic	Mean	Median ± SD	Range	Frequency	%
Age (y)	68.9	70 ± 6.7	47–84
PSA (ng/mL)	1	1.1 ± 0.6	0.2–2
PSAdt (mo)	8.5	6 ± 8.6	0.3–48
PSAVel (ng/mL/y)	8.2	3.7 ± 1.7	0.1–15.6
GS	Median, 7		4–9
TNM	T2cN0M0		T2aN0M0, T4N0M0
Primary therapies
RP				487	80.5
RP + adjuvant RT				118	19.5
Ongoing ADT				148	24.5
Time to relapse (mo)
<12			19.2	116
>12			80.8	489

n = 605 patients.

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TABLE 2

PSA Values and PSA Kinetics in PET-Positive and PET-Negative Patients

Patient	Frequency	%	Mean	Median ± SD	Range
PET-positive	172	28.4
PSA			1.3	1.2 ± 0.5	0.2–2
PSAdt			4.6	3.8 ± 0.3	0.7–21
PSAvel			2.2	1.6 ± 2.1	0.1–15.6
PET-negative	433	71.6
PSA			1.0	1.1 ± 0.5	0.2–2
PSAdt			10.3	7.3 ± 9.7	0.4–48.0
PSAvel			1.1	0.6 ± 1.4	0.1–9.9

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TABLE 3

Univariate and Multivariate Binary Logistic Regression Analysis

	Univariate binary logistic regression				Multivariate binary logistic regression
		95% CI				95% CI
Variable	OR	Lower	Upper	P	OR	Lower	Upper	P
ADT	2.885	1.953	4.262	0.001	1.512	1.026	4.786	0.001
Age	0.936	0.618	1.418	0.754	2.847	0.779	7.896	0.441
GS	2.224	1.233	4.014	0.008	1.089	0.298	3.987	0.897
PSA	1.906	1.399	2.597	0.001	1.913	1.759	4.819	0.016
PSAdt	0.817	0.766	0.871	0.001	0.695	0.552	0.873	0.020
PSAvel	1.502	1.297	1.740	0.001	1.028	0.867	1.219	0.753
TNM	1.037	0.519	2.069	0.919	0.654	0.263	1.626	0.361
TTR	1.356	0.879	2.092	0.169	1.595	0.541	4.704	0.397

TTR = time to relapse.

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TABLE 4

Patient Subpopulations Grouped According to Risk Factors Significantly Related to ¹¹C-Choline PET/CT Positivity and to Prediction of Distant Recurrence Outside Prostate Bed

Population	No. of patients (n)	Overall detection rate (%)	Distant relapse (%)	Locoregional LNs (%)
Overall	605	28.4	14.8	8.3
PSA ≥ 1.05 ng/mL	185	48.6	28.6	9.8
PSAdt < 5.95 mo^*
PSA < 1.05 ng/mL	139	7.9	3.6	2.1
PSAdt ≥ 5.95 mo^*
PSA < 1.05 ng/mL	129	4.6	2.3	1.5
PSAdt ≥ 5.95 mo
Ongoing ADT, no
PSA ≥ 1.05 ng/mL	68	61.8	36.8	17.6
PSAdt < 5.95 mo
Ongoing ADT, yes
PSA < 1.05 ng/mL	76	44.7	21.1	17.1
PSAdt < 5.95 mo^*
PSAdt ≥ 5.95 mo^*	307	16.4	7.2	3.4
PSAdt < 5.95 mo^*	298	47.3	25.9	12.4
PSA < 1.05 ng/mL^*	291	23	10	8.5
PSA ≥ 1.05 ng/mL^*	304	33.4	19.4	8
Ongoing ADT
No	457	22.7	10.9	6.6
Yes	148	46	26.3	14.2