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PET / CT for staging high-risk prostate cancer 18 F-fluorocholine positron emission tomography-computed tomography ( 18 F-FCH PET / CT ) for staging of high-risk prostate cancer patients
| Content Provider | Semantic Scholar |
|---|---|
| Author | Gauvin, Simon Rompré-Brodeur, Alexis Chaussé, Guillaume Maurice Anidjar Bladou, Franck Probst, Stephan |
| Copyright Year | 2018 |
| Abstract | Introduction: We sought to evaluate the diagnostic performance of 18F-fluorocholine positron emission tomography-computed tomography (18F-FCH PET/CT) for initial staging of patients with high-risk prostate cancer. Secondary objectives were to compare the value of 18F-FCH PET/CT to conventional imaging modalities and to evaluate its clinical impact. Methods: We conducted a retrospective study including 76 patients who underwent 18F-FCH PET/CT for initial staging of high-risk prostate cancer. Using pre-established validation criteria, sensitivity and specificity were determined for metastatic disease. Results were compared to findings on magnetic resonance imaging (MRI), computed tomography (CT), and bone scan (BS) when available. Results: Twenty-two (29%) PET/CT scans were positive, 49 (64%) negative, and five (7%) equivocal for nodal or metastatic disease. Of the positive scans, 17 showed regional lymph node involvement, 12 distant nodes, five bone metastases, and three lung metastases. Overall perpatient sensitivity, specificity, positive and negative predictive values for metastatic disease were 65%, 100%, 100%, and 78%, respectively. Sensitivity, specificity, positive and negative predictive values were 64%, 100%, 100% and 80%, respectively, for nodal involvement and 86%, 100%, 100%, and 98% for bone and other metastases. Conventional imaging was negative for the lesion(s) found on PET/CT in five patients. PET/CT changed the clinical management in nine patients (12%). Conclusions: Although 18F-FCH PET/CT offers some benefits over conventional imaging and demonstrates a high specificity, it remains limited by its sensitivity in the context of high-risk prostate cancer staging. PET with novel urea-based small molecule PSMA inhibitors may overcome some of these limitations. However, the interpretation of the study result is limited by the lack of available histological gold standard, the inclusion of several patients who received androgen-deprivation therapy (ADT) prior to PET/CT, our retrospective design, and a relatively small sample size. Introduction Prostate adenocarcinoma (PCa) is the most common cancer among Canadian men. Adequate management of newly diagnosed prostate cancer relies primarily on proper staging and assessment of risk-group stratification. While most of prostate cancer cases are of very-low, low and intermediate-risk category, high-risk prostate cancer represents between 16%-31% of cases at time of diagnosis depending on the classification system used. 3 Notably, the incidence of high-risk localized and metastatic prostate cancer seems to be increasing. Treatment options for high-risk localized prostate cancer include radical prostatectomy (RP) with pelvic lymph node dissection (PLND) or external beam radiation therapy (EBRT) with the addition of androgen deprivation therapy (ADT). If the prostate cancer is metastatic at diagnosis, especially in a highvolume context, it is best managed with systemic therapies such as ADT alone or in combination with chemotherapy or abiraterone. Given the higher likelihood of metastatic disease in the high-risk patients as well as the different available treatment options, accurate detection of nodal or skeletal disease is crucial in this group. For this reason, imaging plays a key role in prostate cancer staging. However, the optimal imaging modality remains an ongoing debate. Most clinicians use a combination of magnetic resonance imaging (MRI), computed tomography (CT) and bone scan (BS) to perform staging despite poor reported sensitivity and specificity. In recent years, nuclear medicine imaging markers have been developed in an attempt to overcome this gap, such as C-Choline and F-fluorocholine (18F-FCH). Choline plays an essential role in the formation of phospholipid membranes and demonstrates increased uptake in prostate cancer cells. The role of 18F-FCH positron emission tomography-computed tomography (PET/CT) in prostate cancer has previously been studied for initial staging and in context of biochemical recurrence with mixed results. In studies looking at the potential role of 18F-FCH PET/CT in initial prostate cancer staging, the benefits seemed to be optimal when investigating high-risk prostate cancer, but the number of patients included in the studies was small and both intermediate and high-risk patients were often analyzed together, which limited extrapolation of results. 15, 17 The primary objective of this study was to evaluate the diagnostic performance of 18FFCH PET/CT for detection of metastatic disease in high-risk prostate cancer patients at the time of initial staging. Secondary objectives were to compare its value to conventional imaging (MRI, CT and BS) and to evaluate its clinical impact. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://cuaj.ca/index.php/journal/article/download/5142/3828/0 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
