Dr. Fanti began his talk by making the point that in order to deem something “obsolete”, this must be based on objective data, particularly since as physicians and patients we are inclined to always be looking for the newest imaging modality, tracer, etc. Dr. Fanti notes that from a safety perspective, both choline and PSMA-PET imaging are safe with very little difference in dosimetry. Importantly, the differences are with regards to diagnostic accuracy, namely sensitivity. In the biochemical recurrence setting, according to Dr. Fanti, choline-PET sensitivity in pooled analysis is only 60%, far below that of PSMA-PET. Furthermore, diagnostic ability is particularly poor for choline-PET when PSA is <1.0 ng/mL (sensitivity ~20%) compared to PSMA-PET sensitivity of 60-70% in this setting. Although not perfect, PSMA-PET certainly outperforms choline-PET in the early biochemical failure setting.
Other considerations comparing choline and PSMA-PET include cost, which as Dr. Fanti notes is difficult to ascertain. In busy centers, Dr. Fanti states that with high-use of scanners, the cost may be as low as €200-300 per patient (not including cost for the tracer) regardless of whether choline or PSMA is used. Secondly, availability is also an important consideration. A few years ago, as Dr Fanti points out, choline was only available in Europe. In current practice, PSMA is increasingly becoming more available, particularly in Australia, Germany, London and in certain locations in the US. Finally, Dr. Fanti notes that the clinical impact on patient management is of the highest relevance. By this metric, choline-PET impacts management for patients in 40% of cases compared to 70% for PSMA-PET. In conclusion, based on the aforementioned criteria, Dr. Fanti regards choline-PET as obsolete.
Presented by: Stefano Fanti, University of Bologna, Bologna, Italy
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
at the #EAU17 -March 24-28, 2017- London, England