Abstract:Purpose/Objective: To optimise therapy regimes in patients with rising PSA levels after radical prostatectomy is difficult. There is no diagnostic tool for early and reliable detection of a locoregional relapse in an ealry stage. We studied 11-C Choline-PET/CT in 45 patients with hormonal suspicion of relapsing prostate cancer. Materials/Methods: Between 07/2002 and 02/2003 45 patients (pts.) (mean age: 65.2 y) with rising PSA levels after radical prostatectomy were investigated. All patients underwent dedicated 11C-Choline-PET/CT from neck to prox. femur (GE Discovery LS). Image fused PET/CT was used to determine local relapse, lymph node (lnn.) involvement or distant metastasis. CT detected lnn.were measured, localised and compared to PET. In case of focal increased 11C-choline uptake the size of lnn. was correlated to the SUV. In PET SUV was measured in case of local recurrence (LR), single ln.or distant metastasis (lnn.,bone) and correlated to the PSA levels. Results: 32/45 patients were positive at PET/CT (PSA mean: 21.6 ng/dl). Local recurrence was found in 3 (PSA 2.4 ng/ml), local recurrence and intrapelvic lymph nodes in 5 patients (PSA 22.9 ng/ml), intrapelvic single nodular relapse in 11 patients (PSA 1.7 ng/ml) and distant lymphonodular metastasis, i.e. paraaortal lymph nodes and intrapelvic regional lymph nodes in 13 patients (PSA 63.9 ng/ml). 7 of these patients had also skeletal metastases. SUV was 2.3 in local recurrence (2.1 in single lymph node relapse and 3.4 in nodular conglomerates). Diameter of 22 intraabdominal lymph nodes positive at PET/CT (12.75 mm, range 4.25mm ? 25.5mm) and 45 intraabdominal nodes negative at PET/CT (11mm, range 4.00mm ? 29.75mm) was not significantly different. Conclusions: The 11-C Choline PET/CTdetects local regional relapse and distant lymphonodular as well as skeletal metastases with high accuracy above the PSA cut off of 0.5 ng/ml. 11-C Choline uptake but not CT measured size is a reliable indicator of lymphonodal involvement in prostate cancer.
Blumstein, N,
Postoperative Dilemma of Rising PSA Levels in Patients with Prostatectomy: Evaluation of 11C-Choline-PET/CT Examination for Radiation Therapy. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3241126.html
