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11C‐acetate positron‐emission tomography/computed tomography imaging for detection of recurrent disease after radical prostatectomy or radiotherapy in patients with prostate cancer
Author(s) -
Esch Lukas Hendrik,
Fahlbusch Melanie,
Albers Peter,
Hautzel Hubertus,
MüllerMattheis Volker
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13706
Subject(s) - medicine , prostatectomy , prostate cancer , positron emission tomography , androgen deprivation therapy , lymph node , radiation therapy , nuclear medicine , prospective cohort study , radiology , prostate specific antigen , urology , cancer
Objectives To evaluate, in a prospective study, the effectiveness of computed tomography ( CT )‐matched 11C‐acetate ( AC ) positron‐emission tomography ( PET ) in patients with prostate cancer ( PC a) who had prostate‐specific antigen ( PSA ) relapse after radical prostatectomy ( RP ) or radiotherapy ( RT ). Patients and Methods In 103 relapsing patients after RP ( n = 97) or RT ( n = 6) AC ‐ PET images and CT scans were obtained. In patients with AC ‐ PET ‐positive results with localized PC a recurrence, detected lesions were resected and histologically verified or, after local RT , followed‐up by PSA testing. Patients with distant disease on AC ‐ PET were treated with androgen deprivation/chemotherapy. Results Of 103 patients, 42 were AC ‐ PET ‐positive. PSA levels were <1.0, <2.0 and <4.0 ng/mL in six, 16 and 20 patients, respectively. In 25/42 patients AC ‐ PET suggested lymph node metastases: 16/25 patients underwent surgery (10/16 metastasis, 6/16 inflammation); 9/25 patients underwent RT of lymph node metastases, which was followed by decreasing PSA level. In 17/42 patients who had distant disease, systemic treatment was commenced. Combining patients who underwent surgery and those who underwent RT , 19/25 patients were true‐positive in terms of AC ‐ PET (positive predictive value 76%). In 5/19 patients, PSA level was <2.0 ng/mL, in 2/19 patients it was <1.0 ng/mL and in 14/19 patients it was 5.4–23.1 ng/mL. In AC ‐ PET ‐positive patients after surgery or RT (without androgen deprivation), median (range) time to renewed PSA increase was 6 (5–9) months. Conclusions Only a minority of patients with relapsing PC a appear to benefit from AC ‐ PET for guiding potential local treatment. False‐positive results show that factors other than tumour metabolism induce increased AC uptake. The time free of recurrence after local treatment was shorter than expected.