Abstract
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Objectives To demonstrate the clinical impact of 18F-Choline PET/CT imaging in detection of isolated prostate cancer local recurrence after nonsurgical initial treatment, leading to different options of individualized salvage therapy.
Methods Twenty-six consecutive prostate cancer pts with rising post-therapeutic PSA, mean age 69 years (range: 57-88), previously treated by external radiotherapy or interstitial brachytherapy were included. Twelve of them showed initial Gleason 7 (46%), 11 patients Gleason 6 (42%), and 2 others Gleason 5 and 8 (8%) scores. In 1 case no Gleason score was available. Dual phase 18F-Choline PET/CT imaging and prostate biopsies were performed in all patients. All pts but one were examined by pelvic MRI (96%).
Results Mean initial pre-therapeutic PSA was 15.5 ng/mL (range: 4.4-88). At diagnosis of biochemical recurrence, mean PSA was 6,6 ng/mL (1.4 to 25). F-Choline PET/CT exam demonstrated positive prostate focal and/or diffuse uptake pattern in 22/26 pts (85%) and pelvic MRI was positive in 24/25 cases (96%). Concordant positive F-Choline PET/CT and MRI results were found in 21/25 pts (84%) and discordant in 4/25 subjects (16%). Histological findings revealed local recurrences in all pts. After biopsies, they benefited from local salvage therapy, i.e. interstitial brachytherapy in 10 pts (38%), external radiotherapy in 9 pts (35%), surgery in 4 pts (15%), and high-intensity focused ultrasound (HIFU) in 3 pts (12%).
Conclusions 18F-Choline PET/CT is an efficient imaging technique to detect prostate cancer local recurrence in patients with rising PSA, showing an important clinical impact on post-therapeutic patient’s management. When confirmed by biopsies, it might lead to different options of individualized salvage therapy.