PT - JOURNAL ARTICLE AU - Mohammed Haseebuddin AU - Farrokh Dehdashti AU - Barry A. Siegel AU - Jingxia Liu AU - Elizabeth B. Roth AU - Kenneth G. Nepple AU - Cary L. Siegel AU - Keith C. Fischer AU - Adam S. Kibel AU - Gerald L. Andriole AU - Tom R. Miller TI - <sup>11</sup>C-Acetate PET/CT Before Radical Prostatectomy: Nodal Staging and Treatment Failure Prediction AID - 10.2967/jnumed.112.111153 DP - 2013 May 01 TA - Journal of Nuclear Medicine PG - 699--706 VI - 54 IP - 5 4099 - http://jnm.snmjournals.org/content/54/5/699.short 4100 - http://jnm.snmjournals.org/content/54/5/699.full SO - J Nucl Med2013 May 01; 54 AB - Despite early detection programs, many patients with prostate cancer present with intermediate- or high-risk disease. We prospectively investigated whether 11C-acetate PET/CT predicts lymph node (LN) metastasis and treatment failure in men for whom radical prostatectomy is planned. Methods: 107 men with intermediate- or high-risk localized prostate cancer and negative conventional imaging findings underwent PET/CT with 11C-acetate. Five underwent LN staging only, and 102 underwent LN staging and prostatectomy. PET/CT findings were correlated with pathologic nodal status. Treatment-failure–free survival was estimated by the Kaplan–Meier method. The ability of PET/CT to predict outcomes was evaluated by multivariate Cox proportional hazards analysis. Results: PET/CT was positive for pelvic LN or distant metastasis in 36 of 107 patients (33.6%). LN metastasis was present histopathologically in 25 (23.4%). The sensitivity, specificity, and positive and negative predictive values of PET/CT for detecting LN metastasis were 68.0%, 78.1%, 48.6%, and 88.9%, respectively. Treatment failed in 64 patients: 25 with metastasis, 17 with a persistent postprostatectomy prostate-specific antigen level greater than 0.20 ng/mL, and 22 with biochemical recurrence (prostate-specific antigen level &gt; 0.20 ng/mL after nadir) during follow-up for a median of 44.0 mo. Treatment-failure–free survival was worse in PET-positive than in PET-negative patients (P &lt; 0.0001) and in those with false-positive than in those with true-negative scan results (P &lt; 0.01), suggesting that PET may have demonstrated nodal disease not removed surgically or identified pathologically. PET positivity independently predicted failure in preoperative (hazard ratio, 3.26; P &lt; 0.0001) and postoperative (hazard ratio, 3.07; P = 0.0001) multivariate models. Conclusion: In patients planned for or completing prostatectomy, 11C-acetate PET/CT detects LN metastasis not identified by conventional imaging and independently predicts treatment-failure–free survival.