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11c-acetate pet/ct accurately predicts prostate-cancer specific survival in patients with biochemical relapse after prostatectomy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University.
2016 (English)In: Journal of Nuclear Medicine, Vol. 57, no supplement 2, p. 521-Article in journal (Refereed) Published
Abstract [en]

521Objectives [11C]-acetate PET/CT is clinically used for re-staging of prostate cancer (PCa) at biochemical relapse after prostatectomy, but the long-term predictive value is not known. This study analysed the prognostic value of [11C]-acetate PET/CT and evaluated PET image metrics in relation to survival.Methods All patients undergoing acetate PET/CT in one institution from 2005-2012 due to PSA-relapse after previous prostatectomy were retrospectively evaluated and clinical data were recorded. Patients were grouped as PCa-specific deaths (Cohort I) or censored (Cohort II). All previously reported findings of local recurrence, regional or distal lymph node metastases and bone metastases were counted and evaluated regarding [11C]-acetate uptake intensity (SUVmax) and tumor volume (TV). Total TV and total lesion activity (TLA, summed SUVmax[asterisk]TV) were calculated. Survival analysis in the entire material was followed by Cox-proportional hazards ratios (HR) analysis in patients with at least one PET-positive finding.Results One-hundred twenty-one patients were included and 22 PCa-specific deaths were registered. Median follow-up time was 79 ± 28 months. Mean PSA at time of PET was 2.69 ± 4.35. Post-operative Gleason score (GS) and PSA at time of PET were higher in Cohort I (both p<0.05). PET/CT identified at least one PCa lesion in 53% of patients. Five-year survival was 79% and 100% for a positive and negative PET, respectively (p<0.001). Univariate HR in PET-positive patients was significantly increased for Post-op GS (1.77, p=0.01), tertile of SUVmax (2.35, p=0.005), tertile of TTV (2.74, p=0.001), tertile of TLA (3.33, p<0.001), number of distal lymph node lesions (1.29, p=0.001) and number of bone metastases (2.16, p<0.001). Stepwise multivariate analysis in PET-positive patients showed statistical significance for post-operative GS (HR 1.85, p=0.04), tertile of TLA (HR 5.51, p=0.03) and number of bone metastases (HR 1.75, p=0.01). Survival analysis of TLA showed statistically significant separation of all tertiles (p<0.001).Conclusions [11C]-acetate PET/CT predicts survival in the setting of PSA-relapse after prostatectomy. Volumetric analysis of tumor burden and metabolic activity has incremental value over anatomical and histopathological staging. A negative scan is associated with superior outcome.

Place, publisher, year, edition, pages
2016. Vol. 57, no supplement 2, p. 521-
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Oncology
Identifiers
URN: urn:nbn:se:uu:diva-403276OAI: oai:DiVA.org:uu-403276DiVA, id: diva2:1388698
Available from: 2020-01-27 Created: 2020-01-27 Last updated: 2020-01-31Bibliographically approved

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