11c-choline-PET/CT versus transrectal ultrasound-guided prostate biopsy to diagnose locally recurrent prostate cancer following radiation therapy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 119-119
Author(s):  
A. Heidenreich ◽  
D. A. Pfister ◽  
R. Epplen ◽  
B. Brehmer
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Prostate Biopsy ◽  
Transrectal Ultrasound ◽  
Ultrasound Guided ◽  
Choline Pet ◽  
Pet Ct ◽  
The Mean ◽  
Locally Recurrent

119 Background: Radical salvage prostatectomy (SRP) represents one local secondary treatment option with curative intent in patients failing radiation therapy (RT) for localized prostate cancer (PCA). 11C-PET/CT represents an innovative imaging study to detect systemic spread of prostate cancer. However, there is only limited experience with regard to the sensitivity of C-PET/CT to detect locally recurrent PCA following radiation therapy. The purpose of our study was to analyse the sensitivity of C-PET/CT to diagnose PCA and extra- and intraprostatic extension. Methods: 45 patients with the suspicion of locally recurrent PCA underwent 12-core transrectal ultrasound- guided biopsy of the prostate, C-PET/CT, bonne scan and radical salvage prostatectomy. Findings of the imaging studies were correlated with the pathohistological findings of the prostate biopsy and the radical prostatectomy specimen. All prostatectomy specimens were proceeded according to the Stanford protocol and the number and location of intraprostatic cancer foci > 5mm were correlated with the PE/CT findings. Results: The mean preoperative serum PSA was 7.8 (2–24) ng/ml; the mean biopsy Gleason Score was 5.6 (4–9). Prostate biopsy was positive in 37/45 (82.2%) patients whereas 8/45 (17.8%) had a negative biopsy despite positive PET/CT findings. PET/CT was positive in 45/45 patients. Radical prostatectomy specimens identified locally recurrent PCA in 44/45 (97.8%). One patient turned out to have pT0pN0 disease despite increasing PSA. PET/CT identified 1, 2, and > 2 intraprostatic cancer foci of significant volume in 23 (51.1%), 13 (28.9%) and 9 (20%) patients, respectively. Sensitivity to detect intraprostatic, histologically proven PCA foci is 95.6% which is significantly superior to the biopsy results. There was a high correlation between the PET/CT results and the final histology of the radical prostatectomy specimens. Conclusions: Choline PET/CT is an innovative imaging to identify patients with locally recurrent PCA following radiation therapy. PET/CT is superior to prostate biopsy and we recommend a PET/CT in patients who are candidates for radical salvage prostatectomy. No significant financial relationships to disclose.

11C-coline-positron emission tomography/computerized tomography (C-PET/CT) for tumor localization of locally recurrent prostate cancer after radiation therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15519-15519
Author(s):  
D. Sahi ◽  
C. Ohlmann ◽  
D. Pfister ◽  
U. Engelmann ◽  
A. Heidenreich
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Prostate Biopsy ◽  
Choline Uptake ◽  
Recurrent Prostate Cancer ◽  
Ct Findings ◽  
Pet Ct ◽  
Locally Recurrent

15519 Background: Radical salvage prostatectomy (sRPE) represents one local secondary treatment option with curative intent in patients failing radiation therapy for localized PCA. C-PET/CT is an innovative imaging technique for the evaluation of PCA. It was the purpose of our study to assess the sensitivity of C-PET/CT to predict local intra- and extraglandular extent of PCA and the presence of lymph node involvement. Methods: 45 patients with biopsy-proven locally recurrent PCA scheduled for sRPE underwent preoperative C-PET/CT. All patients underwent retropubic sRPE with extended pelvic lymphadenectomy. The prostatectomy specimens were processed according to the Stanford protocol and pathohistological results were compared to C-PET/CT findings. Intraglandular location of cancer nodules = 5mm was correlated with PET/CT findings. Results: A total of 45 patients underwent sRPE; mean preop. serum PSA was 7.8 (2–24) ng/ml; mean biopsy Gleason score was 5.6 (4–9). A mean of 19 (10 - 32) lymph nodes were removed. Pathohistology showed stage pT1–2pN0 in 27 (60%), stage pT3a/b and pTxpN1 PCA in 9 (20%) and 9 (20%) of patients, respectively. Positive surgical margins were identified in 5 (11%) patients. C-PET/CT identified 1, 2, 3 or more than 3 intraprostatic cancer nodules in 23 (51.1%), 13 (28.9%) and 9 (20%) patients, respectively. Correlation of prostate biopsy findings with PET/CT findings demonstrated a sensitivity of 90% for PET/CT. There was a low sensitivity for PET/CT detecting lymph node metastases. A positive uptake was identified in 14 (31.1%) patients; pathohistology revealed positive lymph nodes in 9 patients with only 4 patients exhibiting positive 11C-choline uptake and 5 patients having demonstrated a negative preoperative PET/CT scan. Conclusions: C-PET/CT is a valuable imaging modality for the detection of locally recurrent prostate cancer after radiation therapy. Due to its high sensitivity it might replace prostate biopsy prior to sRPE and it might be of additional value in patients with a negative biopsy but a high suspicion of local recurrence. The value of PET/CT for the identification pN1 disease is of modest value and not reliable. No significant financial relationships to disclose.

Prognostic risk factors to predict final pathohistology in patients undergoing radical salvage prostatectomy for locally recurrent prostate cancer after radiation therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15544-15544
Author(s):  
D. Pfister ◽  
C. Ohlmann ◽  
D. Sahi ◽  
U. Engelmann ◽  
A. Heidenreich
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Curative Intent ◽  
Ldr Brachytherapy ◽  
Pet Ct ◽  
The Mean ◽  
Locally Recurrent ◽  
Biopsy Gleason Score

15544 Background: Radical salvage prostatectomy (sRPE) represents one local secondary treatment option with curative intent in patients failing radiation therapy for localized prostate cancer (PCA). Currently, there are very few studies correlating preoperative clinical and pathohistological variables with final pathohistology of sRPE specimens. It was the purpose of our study to identify prognosticators predicting organ confined and locally advanced PCA. Methods: 45 patients with biopsy-proven locally recurrent PCA underwent sRPE and extended pelvic lymphadenectomy (epLA) via a retropubic approach. Preoperative PSA, PSA doubling time, PSA prior to initial radiation therapy, biopsy Gleason score, number of positive biopsies, cT stage, 11choline PET/CT findings, type of radiation therapy, neoadjuvant androgen deprivation were correlated with the pathohistological stage by uni- and multivariate analysis. Results: A total of 45 patients underwent sRPE and epLA; 16 (35.5%), 12 (26.6%) and 17 (37.8%) patients had undergone external beam radiation (EBRT), HDR and LDR brachytherapy, resp. The mean preop. serum PSA was 7.8 (2–24) ng/ml; mean biopsy Gleason score was 5.6 (4–9). We did not encounter significant intraoperative compliations, the mean blood loss was 490 (200–950) ml. A mean of 19 (10 - 32) lymph nodes were removed. Pathohistology showed stage pT1–2pN0 in 27 (60%), stage pT3a/b and pTxpN1 PCA in 9 (20%) and 9 (20%) of patients, respectively. Positive surgical margins were identified in 5 (11%) patients. By multivariate analysis the parameters significantly associated with organ confined PCA sRPE are PSADT > 12 months, = 50% positive biopsy cores, biopsy Gleason score = 7 and previous LDR brachytherapy (pT1–2pN0R0 in all men); pre-radiation and preoperative PSA, PET/CT findings had no significant impact with final pTpN-stage. Conclusions: SRPE can be performed with a low morbidity in biopsy proven locally recurrent PCA after radiotherapy. The identified prognostic parameters will help to select patients most suitable for a local secondary surgical approach with curative intent. Especially in patients with local relapse following LDR brachytherapy sRPE represents a valuable treatment option. No significant financial relationships to disclose.

NOMOGRAM TO PREDICT PROSTATE CANCER DIAGNOSIS ON TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY IN A CONTEMPORARY SERIES

2008 ◽  
Vol 179 (4S) ◽  
pp. 643-644
Author(s):  
Christopher J DiBlasio ◽  
Michael M Maddox ◽  
Reza Mehrazin ◽  
John B Malcolm ◽  
Michael A Aleman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Prostate Biopsy ◽  
Transrectal Ultrasound ◽  
Ultrasound Guided ◽  
Prostate Cancer Diagnosis
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