11C-choline PET/CT in selection of patients for salvage cryoablation in recurrent prostate cancer.

188 Background: 11C-choline PET/CT has proven to be a sensitive technique for re-staging after radiation therapy (RT). The aim of this study was to analyze the clinical impact of 11C-choline-PET/CT in the selection of patients with biochemical recurrence (BCR) after RT for salvage cryoablation of the prostate. Methods: This prospective study was conducted between November 2006 and February 2012 on patients considered as candidates for salvage cryoablation. 74 patients, mean age 69.2 years, median – 70.3 years (range 49-79), who were being followed up after RT for histological proven prostate cancer (according to ASTRO-Phoenix) were included. Until 2009 we used PET/CT fusion, but from 2009 all patients were examined with an integrated PET/CT system. After receiving 400 MBq 11C-choline intravenously, a whole body scan was made. As reference we used biopsy-proven histology from site of suspicion, confirmative imaging modalities (bonescan, CT) or clinical follow-up. PSA doubling time and velocity was calculated. Results: According to the PET/CT results, 40 (54%) patients had a local recurrence, 20 (27%) had regional/distant metastases and 14 (19%) had a negative scan. The positive PET findings were proved by histology from prostate biopsies and/or pelvic lymph node dissections in 63% of cases. Considering PET/CT results: 50/74 (68%) patients received cryoablation, for 24/74 (32%) treatment was changed (active surveillance or androgen deprivation therapy). Conclusions: 11C-choline-PET/CT could be useful for the selection of patients with BCR after RT for salvage cryoablation of the prostate. 11C-choline-PET/CT was decisive and led to therapy change in 32% of cases. [Table: see text]

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Role of whole-body 18F-choline PET/CT in disease detection in patients with biochemical relapse after radical treatment for prostate cancer

La radiologia medica ◽

10.1007/s11547-008-0263-8 ◽

2008 ◽

Vol 113 (6) ◽

pp. 895-904 ◽

Cited By ~ 113

Author(s):

E. Pelosi ◽

V. Arena ◽

A. Skanjeti ◽

V. Pirro ◽

A. Douroukas ◽

...

Keyword(s):

Prostate Cancer ◽

Whole Body ◽

Disease Detection ◽

Biochemical Relapse ◽

Radical Treatment ◽

Choline Pet ◽

Pet Ct

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Correlation of 11c-choline PET-CT with time to treatment and disease-specific survival in men with recurrent prostate cancer after radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.123 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 123-123

Author(s):

A. J. Breeuwsma ◽

J. Pruim ◽

A. M. Leliveld ◽

R. A. Dierckx ◽

I. J. de Jong

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Radical Prostatectomy ◽

Disease Specific Survival ◽

Negative Group ◽

Recurrent Prostate Cancer ◽

Choline Pet ◽

Pet Ct ◽

Disease Specific

123 Background: Restaging with PET-CT in biochemical recurrent prostate cancer after prostatectomy shows a higher frequency of (false) negative cases compared to restaging after EBRT. It is uncertain if this reflects low volume of disease and/or low grade as biopsies fail to prove recurrent cancer in 50% of cases. We followed the clinical course of men with recurrent prostate cancer (PCa) after radical prostatectomy and investigated treatment and survival. PET-CT data were correlated with clinical data, PSA kinetics and disease specific and overall survival. We also studied relative survival comparing an age matched group from the Central Dutch Statistical Office (CBS). Methods: 64 patients underwent 11C-Choline PET-CT on PSA relapse. All patients were initially treated with radical prostectomy and reached PSA nadir of <0.1ng/mL. Recurrent disease was defined as PSA <0.4ng/mL after nadir. Patients were either treated with watchful waiting, adjuvant radiotherapy and/ or androgen deprivation therapy based on individual assesments by the treating urologists. Chi-square, log-rank and Mann-Whitney-U tests were used to study this population Results: The 64 patients had median PSA of 1.4ng/mL. Median follow-up period of patients was 50 (6–124) months. Ten patients died during the course of follow-up of which 5 due to metastasized PCa. No significant differences were seen in age, time to recurrence, total PSA at recurrence and PET-CT results. Patients with abnormal PET had higher PSAVel (median 3.09 ng/mL/yr vs 10.17, p= 0.002) and and shorter PSADT (med 4.83 mo vs 0.53, p= 0.016). Median time to treatment was significantly lower in the PET-CT negative group. Age of patients at death from the whole group did not differ from the age of death in an age matched group. Disease specific survival was significantly higher in the PET-CT negative group (p0.05). Conclusions: A negative 11C-Choline PET-CT correlated with a higher disease specific survival and a lower treatment rate. Overall survival of the group was equal to the age matched cohort. No significant financial relationships to disclose.

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Clinical impact of 11C-Choline PET/CT in selection and outcome of salvage cryoablation in patients with recurrent prostate cancer after radiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.276 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 276-276

Author(s):

Marleen Suzanne Vallinga ◽

Anthonius Breeuwsma ◽

Maxim Rybalov ◽

Jan Pruim ◽

Igle J. De Jong

Keyword(s):

Prostate Cancer ◽

Hormonal Therapy ◽

Biochemical Recurrence ◽

Clinical Impact ◽

Recurrent Prostate Cancer ◽

Choline Pet ◽

Pet Ct ◽

Psa Response ◽

The Impact

276 Background: Salvage cryoablation is an effective but toxic treatment for local recurrent prostate cancer after primary radiotherapy. To assess the location of recurrent prostate cancer, an 11C-choline PET/CT can be used. We studied the clinical impact of 11C-choline PET/CT on the choice for and the results of salvage cryoablation. Methods: A total of 141 patients with a biochemical recurrence (BCR according to ASTRO-Phoenix criteria) after radiotherapy, and thus candidates for salvage cryoablation, were included. Patients were re-staged with an 11C-choline PET/CT, complementary prostate biopsies, when indicated a pelvic lymph node dissection and/or additional imaging. Change in choice of therapy was defined as major (no salvage cryoablation because of metastases or lack of local recurrence on PET/CT), minor (local salvage treatment was performed, but different technique of after additional diagnostics) or none (salvage cryoablation was performed). The impact of selection of patients for cryoablation with PET/CT on outcome was measured by time from cryoablation to BCR (according to Astro-Phoenix), first distant metastasis and start of hormonal therapy. Results: In 71 of 141 patients (51%) a change in therapy was implemented because of the result of 11C-choline PET/CT. A major impact was observed in 48 (34%) patients. In 83 patients, a salvage cryoablation was performed (59%). 18% of this group showed no PSA response. Of the remaining patients with PSA response, 37% developed a BCR after mean 25.7 months. 47% of patients are still in remission after a mean follow-up of 43 months. In 16 of 83 patients (19%) metastases were proven after mean 55.4 months (SD 26.3). 15 patients started with hormonal therapy, mean 29.5 months (SD 20.1) after cryoablation. Conclusions: 11C-choline PET/CT showed a significant impact on selection for salvage cryoablation. The choice for local salvage therapy was abandoned in 34% of patients. Of the men who underwent a salvage cryoablation, 47% stayed free of biochemical recurrence during mean 43 months follow-up.

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ROLE OF KINETIC PERFORMANCE OF PSA IN SELECTION OF THE PATIENTS FOR CONDUCTION OF ¹¹C-CHOLINE PET/CT AIMED TO REVEAL LOCAL RECURRENCES OF PROSTATE CANCER

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2015-174-6-25-28 ◽

2015 ◽

Vol 174 (6) ◽

pp. 25-28

Author(s):

M. A. Rybalov ◽

I. Ya. De Iong ◽

A. I. Breusma ◽

S. Kh. Al’-Shukri ◽

S. Yu. Borovets

Keyword(s):

Prostate Cancer ◽

Growth Rate ◽

Radiation Therapy ◽

Tumor Recurrence ◽

Doubling Time ◽

Local Recurrences ◽

Choline Pet ◽

Pet Ct ◽

Selection Of

Given study was aimed to research a role of kinetic performance of PSA in selection of the patients for conduction ¹¹C-choline PET/CT in order to reveal local recurrences in patient with prostate cancer after radiation therapy (RT) and radical prostatectomy (RP). The study included 185 patients with histologically distinctive prostate cancer and biochemical signs of tumor recurrence after RP (61 patients) or RT (124 patients). All the patients were examined using ¹¹C-choline PET/ CT in order to detect local relapses. Calculation of growth rate of the PSA level and PSA doubling time were made. According to results of ¹¹C-choline PET/CT, recurrences of prostate cancer were detected in 124 out of 185 (65%). There were 22 patients out of 61 (36%) after RP and there were 102 patients out of 124 (82%) after RT. It was stated a correlation between PSA rates, growth rate of PSA level and presence or absence of relapse according to PET/CT results. PSA level and growth rate of PSA were indicated as the most significant predictive signs, which could influence on the selection of the patients for conduction of ¹¹C-choline PET/CT in relation to detection of local recurrence after RT and RP.

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The relationship between local recurrences and distant metastases in prostate cancer: can 11C-choline PET/CT contribute to understand the link?

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-018-3944-0 ◽

2018 ◽

Vol 45 (6) ◽

pp. 962-969 ◽

Cited By ~ 1

Author(s):

Giampiero Giovacchini ◽

Andrea Ciarmiello ◽

Elisabetta Giovannini ◽

Andrei Fodor ◽

Cesare Cozzarini ◽

...

Keyword(s):

Prostate Cancer ◽

Distant Metastases ◽

Local Recurrences ◽

Choline Pet ◽

Pet Ct ◽

The Relationship

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Oligometastatic prostate cancer: An evaluation of stereotactic body radiotherapy (SBRT) as an alternative to palliative androgen deprivation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.229 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 229-229

Author(s):

Daniel Robert Henderson ◽

Alison Tree ◽

Helen Taylor ◽

Vincent Khoo ◽

Nicholas John Van As

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Stereotactic Body Radiotherapy ◽

Free Survival ◽

Choline Pet ◽

Pet Ct ◽

Oligometastatic Prostate Cancer

229 Background: Oligometastatic prostate cancer (OPC) can be defined as 1-3 sites of metastasis, typically occurring some years after radical treatment for primary disease. Standard treatment is long-term palliative androgen deprivation therapy (ADT). Although effective, this treatment can have a significant impact on quality of life. We hypothesized that ablative treatment with SBRT may delay disease progression, and therefore the need for palliative ADT. Methods: A single-institution case series 2011-present. Eligible patients had metachronous OPC diagnosed by F-choline PET/CT and were ADT-naïve in the palliative setting. Stereotactic body radiotherapy was given to a dose of 30 Gy in 3 fractions using a robotic radiosurgery system (Cyberknife). ADT-free survival was calculated as the time from completion of treatment for oligometastatic disease to initiation of ADT with palliative intent. Follow up with clinical review and PSA was undertaken at four weeks, then three monthly, with F-choline PET/CT restaging as indicated. Palliative ADT was initiated for metastatic disease not amenable to further SBRT. Results: Twenty one patients received SBRT for ADT-naïve OPC. Median time from primary treatment to oligometastatic relapse was 59.7 months. Median PSA doubling time was 4.1 months. Six patients received a short course (3-6 months) of ADT with SBRT. Sites treated: bone (8) and lymph node (20). At a median follow up of 16.7 months, 81% (17) remained ADT-free. Median ADT-free survival was 28 months (95% CI: 10 - 43 months). All but one patient had a PSA response, with a median reduction of 84%. There were no local failures. Incidence of grade 1 and 2 CTCAE toxicity was 29% (6) and 5% (1), respectively. No toxicity of grade 3 or above was observed. Conclusions: SBRT for OPC is well tolerated. A clinically significant delay in initiation of palliative ADT was observed in patients with ADT-naïve oligometastatic disease. In view of this potential to improve patients’ quality of life, randomised trials against a standard of care are justified.

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267 CLINICAL STAGING AND RE-STAGING IN PROSTATE CANCER: COMPARISON OF 11C-CHOLINE-PET/CT AND WHOLE BODY MRI

European Urology Supplements ◽

10.1016/s1569-9056(07)60266-8 ◽

2007 ◽

Vol 6 (2) ◽

pp. 89 ◽

Cited By ~ 3

Author(s):

S.M. Eschmann ◽

D. Schilling ◽

C. Pfannenberg ◽

A. Rieger ◽

M.P. Lichy ◽

...

Keyword(s):

Prostate Cancer ◽

Clinical Staging ◽

Whole Body ◽

Whole Body Mri ◽

Choline Pet ◽

Pet Ct

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11C-choline PET/CT and whole-body MRI including diffusion-weighted imaging for patients with recurrent prostate cancer

Oncotarget ◽

10.18632/oncotarget.16227 ◽

2017 ◽

Vol 8 (39) ◽

pp. 66516-66527 ◽

Cited By ~ 14

Author(s):

Hinrich Wieder ◽

Ambros J. Beer ◽

Konstantin Holzapfel ◽

Martin Henninger ◽

Tobias Maurer ◽

...

Keyword(s):

Prostate Cancer ◽

Diffusion Weighted Imaging ◽

Whole Body ◽

Recurrent Prostate Cancer ◽

Whole Body Mri ◽

Choline Pet ◽

Diffusion Weighted ◽

Pet Ct

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The 68Ga/177Lu-theragnostic concept in PSMA-targeting of metastatic castration–resistant prostate cancer: impact of post-therapeutic whole-body scintigraphy in the follow-up

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-019-04583-2 ◽

2019 ◽

Vol 47 (3) ◽

pp. 695-712 ◽

Cited By ~ 5

Author(s):

Johanna Maffey-Steffan ◽

Lorenza Scarpa ◽

Anna Svirydenka ◽

Bernhard Nilica ◽

Christian Mair ◽

...

Keyword(s):

Prostate Cancer ◽

Therapeutic Option ◽

Whole Body ◽

Castration Resistant Prostate Cancer ◽

The Third ◽

Castration Resistant ◽

Mixed Response ◽

Pet Ct ◽

Post Therapy

Abstract Introduction A new therapeutic option for metastatic castration–resistant prostate cancer (mCRPC) of heavily pre-treated patients lies in 177Lu-PSMA-617 radioligand therapy. Methods On the basis of PSMA-targeted 68Ga-PSMA-11 PET/CT, 32 consecutive mCRPC patients were selected for 177Lu-PSMA-617 therapy (6 GBq/cycle, 2 to 6 cycles, 6–10 weeks apart) and followed until death. Post-therapy whole-body (WB) dosimetry and 68Ga-PSMA-11 PET/CT data were compared and related to progression free and overall survival. Results 177Lu-PSMA-617 dosimetry after the first cycle indicated high tumor doses for skeletal (4.01 ± 2.64; range 1.10–13.00 Gy/GBq), lymph node (3.12 ± 2.07; range 0.70–8.70 Gy/GBq), and liver (2.97 ± 1.38; range 0.76–5.00 Gy/GBq) metastases whereas the dose for tissues/organs was acceptable in all patients for an intention-to-treat activity of 24 GBq. Any PSA decrease after the first cycle was found in 23/32 (72%), after the second cycle in 22/32 (69%), after the third cycle in 16/28 (57%), and after the fourth cycle in 8/18 (44%) patients. Post-therapy 24 h WB scintigraphy showed decreased tumor-to-background ratios in 24/32 (75%) after the first therapy cycle, after the second cycle in 17/29 (59%), and after the third cycle in 13/21 (62%) patients. The median PFS was 7 months and the median OS 12 months. In the group of PSA responders (n = 22) the median OS was 17 months versus 11 months in the group of non-responders (n = 10), p < 0.05. Decreasing SUVmax values were found for parotid (15.93 ± 6.23 versus 12.33 ± 4.07) and submandibular glands (17.65 ± 7.34 versus 13.12 ± 4.62) following treatment, along with transient (n = 6) or permanent (n = 2) xerostomia in 8/32 (25%) patients. In 3/32 patients, nephrotoxicity changed from Grade 2 to 3, whereas neither Grade 4 nephrotoxicity nor hematotoxicity was found. In most patients a good agreement was observed for the visual interpretation of the tracer accumulation between 24 h WB and PET/CT scans. However, no significance could be calculated for baseline-absorbed tumor doses and SUVmax values of tumor lesions. 5/32 (16%) patients showed a mixed response pattern, which resulted in disease progression over time. Conclusion Serial PSA measurements and post-therapy 24 h WB scintigraphy seems to allow a sufficiently accurate follow-up of 177Lu-PSMA-617-treated mCRPC patients whereas 68Ga-PSMA-11 PET/CT should be performed for patient selection and final response assessment.

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