Fluorocholine PET-CT and MRI in recurrent prostate cancer. Three years’ experience in clinical practice

Objectives Evaluate the clinical impact of 18F-Fluorocholine PET-CT (FCHPCT) and MRI in recurrent prostate cancer

Methods From 11/2011 to 11/2014, 51 patients underwent FCHPCT after PSA relapse (or persistent disease) after radical prostatectomy. Previously 3T-multiparametric MRI was performed and its findings were correlated with PET-CT. Locoregional and distant relapse were found, and treatment (radiotherapy and/or hormonotherapy) was prescribed.

Results 66% of FCHPCT detected locoregional or distant disease. 43% of the patients with positive FCHPCT had PSA <1 ng/ml. In 62.5% locoregional relapse was detected both by FCHPCT and/or MRI. In 21% FCHPCT also detected distant metastases. In the remaining only increasing PSA was detected after surgery. In 47% of locoregional relapses, PSA was> 2ng/ml. In 47% of these pelvic recurrences, 3T-MRI findings were correlated with 18F-PCT. All pts with systemic relapse demonstrated by FCHPCT were considered High Risk (NCCN criteria) after surgery. The timing of relapse was less than two years after surgery. In 100% of pts who received radiotherapy (17), IMRT was performed using FCHPCT simulation. In 35% , simultaneous boost technique was delivered using three different treatment volumes (surgical bed, pelvic lymph nodes, and affected lymph nodes). FCHPCT caused clinical practice modifications in 21%.

Conclusions 18F-Fluorocholine PET/CT and PET-MRI imaging are useful for detection of locoregional and/or distant recurrent disease in prostate cancer. Its clinical use has important implications in the management of these patients, especially in radiation treatment planning