Positron emission tomography/computed tomography with F-18-fluorocholine for restaging of prostate cancer patients:: Meaningful at PSA < 5 ng/ml?
Positron emission tomography/computed tomography with F-18-fluorocholine for restaging of prostate cancer patients:: Meaningful at PSA < 5 ng/ml?
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DOI：
10.1007/s11307-005-0023-2
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发表时间：
2006-01-01
影响因子：
3.1
通讯作者：
Langsteger, W
中科院分区：
文献类型：
--
作者：
Heinisch, M;Dirisamer, A;Langsteger, W
据报道，使用碳 - 11 - 胆碱的正电子发射断层扫描（PET）对前列腺癌患者进行再分期时，在前列腺特异抗原（PSA）水平<5 ng/ml时未能得出阳性结果。因此，我们研究的目的是确定使用氟 - 18 - 氟胆碱的PET/CT（FCH PET/CT）是否也是如此，或者即使在较低的PSA水平下，FCH PET/CT是否有可能得出真阳性结果。
方法：34例前列腺癌患者接受了初始治疗（根治性前列腺切除术31例，放疗3例），在随访期间，如果PSA水平可检测到或升高，则使用氟 - 18 - 氟胆碱（FCH）进行PET/CT扫描。检查时测定所有患者的当前PSA水平。
结果：FCH阳性患者的PSA中位数为6.1 ng/ml（平均PSA为17.1 ng/ml），FCH阴性患者的PSA中位数为2.3 ng/ml（平均PSA为3.4 ng/ml），差异有统计学意义（p < 0.05）。在PSA < 5 ng/ml的17次检查中，有8次（47%）检测到至少一个FCH阳性病灶。到目前为止，在PSA < 5 ng/ml的8例FCH阳性病例中，有7例分别通过相关的影像学方法（CT和/或MR）、活检/组织学以及疾病病程得到了证实，因此在PSA < 5 ng/ml的17次检查中，共有7次（41%）获得了真阳性的FCH PET/CT结果。在这7例PSA < 5 ng/ml的FCH PET阳性患者中，有4例在检查时或检查前接受了辅助激素治疗。
结论：在前列腺癌患者的再分期中，即使PSA < 5 ng/ml，FCH PET/CT也能够得出真阳性结果。因此，FCH PET/CT不应局限于PSA > 5 ng/ml的患者。
According to reports, re-staging of patients suffering from prostate cancer by positron emission tomography (PET) using C-11-choline has failed to produce positive findings at a PSA level of < 5 ng/ml. Hence, the purpose of our study has been to determine whether this is true also for PET/CT using F-18-fluorocholine (FCH PET/CT) or whether it is possible to obtain true positive results by FCH PET/CT even at lower PSA levels.Methods: In 34 patients with prostate cancer who had undergone initial therapy (radical prostatectomy n = 31, radiotherapy n = 3), a PET/CT scan was performed using F-18-fluorocholine (FCH) during follow-up in case of demonstrable or rising PSA levels. Current PSA levels were determined in all patients at the time of examination.Results: Median PSA in FCH positive patients was 6.1 ng/ml (mean PSA 17.1 ng/ml), median PSA in FCH negative patients was 2.3 ng/ml (mean PSA 3.4 ng/ml), respectively (p < 0.05). In eight of 17 examinations (47%) with PSA < 5 ng/ml, at least one FCH-positive focus was detected. So far the findings could be confirmed by correlating imaging methods (CT and/or MR), biopsy/histology and the course of the disease, respectively, in seven of the eight FCH-positive cases with PSA < 5 ng/ml, so that a true positive FCH PET/CT finding was obtained all in all in seven of 17 (41%) examinations with PSA < 5 ng/ml. In four of these seven FCH PET-positive patients with PSA < 5 ng/ml, adjuvant hormonal therapy was administered at the time of the examination or prior to the examination.Conclusion: In re-staging patients with prostate cancer, FCH PET/CT is able to yield true positive findings even at PSA < 5 ng/ml. Therefore, FCH PET/CT should not be restricted to patients with PSA > 5 ng/ml.