Paolo Castellucci MD, Presenter: Nothing to Disclose

Cristina Nanni, Abstract Co-Author: Nothing to Disclose

Mohsen Farsad MD, Abstract Co-Author: Nothing to Disclose

Stefano Fanti MD, Abstract Co-Author: Nothing to Disclose

Romeo Canini, Abstract Co-Author: Nothing to Disclose

Riccardo Schiavina, Abstract Co-Author: Nothing to Disclose

Available diagnostic methods for prostate cancer have low sensitivity, frequently leading to iterative biopsies. Aim of our study was to evaluate the potential usefulness of 11C-Choline PET/CT for intra prostate tumor detection and localization, in order to guide and increase biopsy sensitivity.

We reviewed the results of PET/CT scans in 36 pts (mean age 63,4;mean PSA 12,3 ng/ml.) with localized prostate cancer, who subsequently underwent radical prostatectomy (RP). As control group we enrolled 5 pts with bladder cancer who underwent cystectomy and prostatectomy. After RP, the gland was divided into sextants: presence and location of cancer foci and prostate intraepithelial neoplasm (PIN) were determined by two pathologists.PET/CT was performed 5 min after injection of 11C-choline (370-400 MBq) and the presence of prostate cancer in each sextant was assessed semi quantitatively by measuring SUVmax and TBR: TBR>1.5 was considered positive. Results of PET/CT imaging were compared with histology.

On a sextant basis histopatological analysis identified cancer foci in 143/216 sextants; high grade PIN (HGPIN) foci were detected in 89/216 sextants (in 59 sextants in association with carcinoma, in 30 sextants alone), acute prostatitis in 7/216 sextants (in 3 sextants in association with carcinoma, in 4 sextants alone) whereas 39/216 sextants were normal. PET/CT demonstrated focal 11C-Choline uptake in 108 sextants: 94/108 were involved by tumor, 10/108 by HGPIN, 2/108 by HGPIN and acute prostatitis and 2/108 were normal at histology. In 108 sextants there was no abnormal 11C-Choline uptake: 58/108 were true negative while 50/108 resulted to be falsely negative. Values of sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT were respectively 64%, 82%, 70%, 87% and 54%.

Our data demonstrate that 11C-Cho PET/CT may help detect intra prostate cancer. In pts with iterative and negative TRUS guided biopsy and a persistence of an high risk of prostate cancer, 11C-Cho PET/CT may be suggested to increase the detection rate of cancer. Further studies are needed to assess the usefulness of 11C-Choline PET/CT in clinical practice.

P.C.,C.N.,M.F.,S.F.,R.C.,R.S.: The undersigned authors transfer all copyright ownership of the manuscript entitled “Localization of Prostate Cancer with 11c-Choline PET/CT” to RSNA in the event the work is published. The undersigned authors warrant that the article is original, does not infringe upon any copyright or other propietary right of any third party, is nor under consideration by another journal, and has not been previously published. The final manuscript has been read, and each author’s contribution has been approved by appropriate author. We attest that we have not and will not distribute copies or reprints of this paper for commercial use prior to its publlication in Medical Science Monitor. We further attest that we herein disclosed any and all financial or other relationships which could be construed as a conflict of interest and that all sources of financial support for this study have been disclosed and are indicated in the acknowledgment.

Available diagnostic methods for prostate cancer have low sensitivity, frequently leading to iterative biopsies. Aim of our study was to evaluate the potential usefulness of 11C-Choline PET/CT for intra prostate tumor detection and localization, in order to guide and increase biopsy sensitivity.

We reviewed the results of PET/CT scans in 36 pts (mean age 63,4;mean PSA 12,3 ng/ml.) with localized prostate cancer, who subsequently underwent radical prostatectomy (RP). As control group we enrolled 5 pts with bladder cancer who underwent cystectomy and prostatectomy. After RP, the gland was divided into sextants: presence and location of cancer foci and prostate intraepithelial neoplasm (PIN) were determined by two pathologists.PET/CT was performed 5 min after injection of 11C-choline (370-400 MBq) and the presence of prostate cancer in each sextant was assessed semi quantitatively by measuring SUVmax and TBR: TBR>1.5 was considered positive. Results of PET/CT imaging were compared with histology.

On a sextant basis histopatological analysis identified cancer foci in 143/216 sextants; high grade PIN (HGPIN) foci were detected in 89/216 sextants (in 59 sextants in association with carcinoma, in 30 sextants alone), acute prostatitis in 7/216 sextants (in 3 sextants in association with carcinoma, in 4 sextants alone) whereas 39/216 sextants were normal. PET/CT demonstrated focal 11C-Choline uptake in 108 sextants: 94/108 were involved by tumor, 10/108 by HGPIN, 2/108 by HGPIN and acute prostatitis and 2/108 were normal at histology. In 108 sextants there was no abnormal 11C-Choline uptake: 58/108 were true negative while 50/108 resulted to be falsely negative. Values of sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT were respectively 64%, 82%, 70%, 87% and 54%.

Our data demonstrate that 11C-Cho PET/CT may help detect intra prostate cancer. In pts with iterative and negative TRUS guided biopsy and a persistence of an high risk of prostate cancer, 11C-Cho PET/CT may be suggested to increase the detection rate of cancer. Further studies are needed to assess the usefulness of 11C-Choline PET/CT in clinical practice.

P.C.,C.N.,M.F.,S.F.,R.C.,r.s.:

Castellucci, P, Nanni, C, Farsad, M, Fanti, S, Canini, R, Schiavina, R, Localization of Prostate Cancer with 11c-Choline PET/CT.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4407598.html