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Influence of trigger PSA and PSA kinetics on 11C-Choline PET/CT detection rate in patients with biochemical relapse after radical prostatectomy.
J Nucl Med. 2009 Sep; 50(9):1394-400.JN

Abstract

The purpose of this study was to investigate the effect of total prostate-specific antigen (PSA) at the time of (11)C-choline PET/CT (trigger PSA), PSA velocity (PSAvel), and PSA doubling time (PSAdt) on (11)C-choline PET/CT detection rate in patients treated with radical prostatectomy for prostate cancer, who showed biochemical failure during follow-up.

METHODS

A total of 190 patients treated with radical prostatectomy for prostate cancer who showed an increase in PSA (mean, 4.2; median, 2.1; range, 0.2-25.4 ng/mL) were retrospectively enrolled. All patients were studied with (11)C-choline PET/CT. Patients were grouped according to trigger PSA (PSA </= 1 ng/mL, 1 < PSA </= 2 ng/mL, 2 < PSA </= 5 ng/mL, and PSA > 5 ng/mL). In 106 patients, data were available for calculation of PSAvel and PSAdt. Logistic regression analysis was used to determine whether there was a relationship between PSA levels and PSA kinetics and the rate of detection of relapse using PET.

RESULTS

(11)C-choline PET/CT detected disease relapse in 74 of 190 patients (38.9%). The detection rate of (11)C-choline PET/CT was 19%, 25%, 41%, and 67% in the 4 subgroups-PSA </= 1 ng/mL (51 patients), 1 < PSA </= 2 ng/mL (39 patients), 2 < PSA </= 5 ng/mL (51 patients), and PSA > 5 ng/mL (49 patients)-respectively. Trigger PSA values were statistically different between PET-positive patients (median PSA, 4.0 ng/mL) and PET-negative patients (median PSA, 1.4 ng/mL) (P = 0.0001). Receiver-operating-characteristic analysis showed an optimal cutoff point for trigger PSA of 2.43 ng/mL (area under the curve, 0.76). In 106 patients, PSAdt and PSAvel values were statistically different between patients with PET-positive and -negative scan findings (P = 0.04 and P = 0.03). The (11)C-choline PET/CT detection rate was 12%, 34%, 42%, and 70%, respectively, in patients with PSAvel < 1 ng/mL/y (33 patients), 1 < PSAvel </= 2 ng/mL/y (26 patients), 2 < PSAvel </= 5 ng/mL/y (19 patients), and PSAvel > 5 ng/mL/y (28 patients). The (11)C-choline PET/CT detection rate was 20%, 40%, 48%, and 60%, respectively, in patients with PSAdt > 6 mo (45 patients), 4 < PSAdt </= 6 mo (20 patients), 2 < PSAdt </= 4 mo (31 patients), and PSAdt </= 2 mo (10 patients). There was no statistical difference between PET-positive and -negative scan detection rates according to the Gleason score, pT and N status, patient age, or duration between surgery and biochemical relapse. Trigger PSA and PSAvel were found to be independent predictive factors for a PET-positive result (P = 0.002; P = 0.04) and PSAdt was found to be an independent factor only in patients with trigger PSA less than 2 ng/mL (P = 0.05) using multivariate analysis.

CONCLUSION

The (11)C-choline PET/CT detection rate is influenced by trigger PSA, PSAdt, and PSAvel. This finding could be used to improve the selection of patients for scanning by reducing the number of false-negative scans and increasing the detection rate of disease in patients with early relapse and potentially curative disease.

Authors+Show Affiliations

Nuclear Medicine Unit, Hematology-Oncology and Laboratory Medicine Department, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy. paolo.castellucci@aosp.bo.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19690023

Citation

Castellucci, Paolo, et al. "Influence of Trigger PSA and PSA Kinetics On 11C-Choline PET/CT Detection Rate in Patients With Biochemical Relapse After Radical Prostatectomy." Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, vol. 50, no. 9, 2009, pp. 1394-400.
Castellucci P, Fuccio C, Nanni C, et al. Influence of trigger PSA and PSA kinetics on 11C-Choline PET/CT detection rate in patients with biochemical relapse after radical prostatectomy. J Nucl Med. 2009;50(9):1394-400.
Castellucci, P., Fuccio, C., Nanni, C., Santi, I., Rizzello, A., Lodi, F., Franceschelli, A., Martorana, G., Manferrari, F., & Fanti, S. (2009). Influence of trigger PSA and PSA kinetics on 11C-Choline PET/CT detection rate in patients with biochemical relapse after radical prostatectomy. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, 50(9), 1394-400. https://doi.org/10.2967/jnumed.108.061507
Castellucci P, et al. Influence of Trigger PSA and PSA Kinetics On 11C-Choline PET/CT Detection Rate in Patients With Biochemical Relapse After Radical Prostatectomy. J Nucl Med. 2009;50(9):1394-400. PubMed PMID: 19690023.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of trigger PSA and PSA kinetics on 11C-Choline PET/CT detection rate in patients with biochemical relapse after radical prostatectomy. AU - Castellucci,Paolo, AU - Fuccio,Chiara, AU - Nanni,Cristina, AU - Santi,Ivan, AU - Rizzello,Anna, AU - Lodi,Filippo, AU - Franceschelli,Alessandro, AU - Martorana,Giuseppe, AU - Manferrari,Fabio, AU - Fanti,Stefano, Y1 - 2009/08/18/ PY - 2009/8/20/entrez PY - 2009/8/20/pubmed PY - 2009/10/23/medline SP - 1394 EP - 400 JF - Journal of nuclear medicine : official publication, Society of Nuclear Medicine JO - J. Nucl. Med. VL - 50 IS - 9 N2 - UNLABELLED: The purpose of this study was to investigate the effect of total prostate-specific antigen (PSA) at the time of (11)C-choline PET/CT (trigger PSA), PSA velocity (PSAvel), and PSA doubling time (PSAdt) on (11)C-choline PET/CT detection rate in patients treated with radical prostatectomy for prostate cancer, who showed biochemical failure during follow-up. METHODS: A total of 190 patients treated with radical prostatectomy for prostate cancer who showed an increase in PSA (mean, 4.2; median, 2.1; range, 0.2-25.4 ng/mL) were retrospectively enrolled. All patients were studied with (11)C-choline PET/CT. Patients were grouped according to trigger PSA (PSA </= 1 ng/mL, 1 < PSA </= 2 ng/mL, 2 < PSA </= 5 ng/mL, and PSA > 5 ng/mL). In 106 patients, data were available for calculation of PSAvel and PSAdt. Logistic regression analysis was used to determine whether there was a relationship between PSA levels and PSA kinetics and the rate of detection of relapse using PET. RESULTS: (11)C-choline PET/CT detected disease relapse in 74 of 190 patients (38.9%). The detection rate of (11)C-choline PET/CT was 19%, 25%, 41%, and 67% in the 4 subgroups-PSA </= 1 ng/mL (51 patients), 1 < PSA </= 2 ng/mL (39 patients), 2 < PSA </= 5 ng/mL (51 patients), and PSA > 5 ng/mL (49 patients)-respectively. Trigger PSA values were statistically different between PET-positive patients (median PSA, 4.0 ng/mL) and PET-negative patients (median PSA, 1.4 ng/mL) (P = 0.0001). Receiver-operating-characteristic analysis showed an optimal cutoff point for trigger PSA of 2.43 ng/mL (area under the curve, 0.76). In 106 patients, PSAdt and PSAvel values were statistically different between patients with PET-positive and -negative scan findings (P = 0.04 and P = 0.03). The (11)C-choline PET/CT detection rate was 12%, 34%, 42%, and 70%, respectively, in patients with PSAvel < 1 ng/mL/y (33 patients), 1 < PSAvel </= 2 ng/mL/y (26 patients), 2 < PSAvel </= 5 ng/mL/y (19 patients), and PSAvel > 5 ng/mL/y (28 patients). The (11)C-choline PET/CT detection rate was 20%, 40%, 48%, and 60%, respectively, in patients with PSAdt > 6 mo (45 patients), 4 < PSAdt </= 6 mo (20 patients), 2 < PSAdt </= 4 mo (31 patients), and PSAdt </= 2 mo (10 patients). There was no statistical difference between PET-positive and -negative scan detection rates according to the Gleason score, pT and N status, patient age, or duration between surgery and biochemical relapse. Trigger PSA and PSAvel were found to be independent predictive factors for a PET-positive result (P = 0.002; P = 0.04) and PSAdt was found to be an independent factor only in patients with trigger PSA less than 2 ng/mL (P = 0.05) using multivariate analysis. CONCLUSION: The (11)C-choline PET/CT detection rate is influenced by trigger PSA, PSAdt, and PSAvel. This finding could be used to improve the selection of patients for scanning by reducing the number of false-negative scans and increasing the detection rate of disease in patients with early relapse and potentially curative disease. SN - 0161-5505 UR - https://www.unboundmedicine.com/medline/citation/19690023/Influence_of_trigger_PSA_and_PSA_kinetics_on_11C_Choline_PET/CT_detection_rate_in_patients_with_biochemical_relapse_after_radical_prostatectomy_ L2 - http://jnm.snmjournals.org/cgi/pmidlookup?view=long&amp;pmid=19690023 DB - PRIME DP - Unbound Medicine ER -