"Real-world" evaluation of 18F-Choline PET/CT practices in prostate cancer patients and impact on changes in therapeutic strategy.

The role of 18F-fluorocholine positron emission tomography/computed tomography (18F-Choline PET/CT) in different clinical situations remains controversial and current practices are very heterogeneous. The aim of this study was to evaluate the "real-world" practice of 18F-Choline PET/CT in patients with prostate cancer and its potential impacts on therapeutic strategy.

This is a retrospective multicenter observational study including 265 consecutive men who underwent 18F-Choline PET/CT for prostate cancer between November 2014 and November 2015. Primary outcome was impact on therapeutic strategy. Secondary outcomes were sensitivity of the 18F-Choline PET/CT and predictive factors associated with positive scans. Statistical analyses comprised Student's t test for continuous variables or chi-squared test for qualitative variables.

Median PSA level at the time of PET/CT was 4.19 ng/ml. The decision to perform PET/CT was made after multidisciplinary discussion in 29.8% of cases; most were prescribed by urologists (50.2% of cases). Three main indications were concerned: biochemical recurrence after local treatment (61.1%), initial staging (26.0%), or at the time of progression to castration-resistance (12.9%). Upon biochemical recurrence, 18F-Choline PET/CT allowed identification of ≥1 site(s) with a sensitivity of 80.9%. In multivariate analysis, predictive factors associated with 18F-Choline PET/CT sensitivity were serum PSA level and local treatment type in cases of biochemical recurrence, and PSA doubling time and Gleason score in case of initial staging. 18F-Choline PET/CT results allowed restaging and change in therapeutic strategy in 58.1% of all combined indications.

Indications of 18F-Choline PET/CT were varied. The detection rate of metastatic lesions was suitable, especially when PSA rate was >1 ng/mL. In most cases, 18F-Choline PET/CT led to a change in therapeutic strategy, particularly in the setting of biochemical recurrence.

Urologic oncology. 2019 Aug 22 [Epub ahead of print]

Vincent Niziers, Romain Boissier, Delphine Borchiellini, Jean-Laurent Deville, Cédric Khoury, Matthieu Durand, Harry Toledano, Thomas Albert, Nicolas Branger, Quentin Bandelier, Matthieu-John Ouvrier, Sophie Gabriel, Benjamin Hoch, Emmanuel Gross, Jochen Walz, Isabelle Brenot-Rossi, Géraldine Pignot

Department 2 of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France., Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance Publique -Hôpitaux de Marseille, Marseille, France., Department of Oncology, Antoine-Lacassagne Center, Nice, France., Service d'Oncologie Médicale, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France., Centre Saint Louis; Pierre Guillet, Hôpital Font-Pré, Toulon, France., Service d'urologie, d'andrologie et de transplantation rénale, Université de Nice-Sophia-Antipolis, Hôpital Pasteur 2, Centre hospitalier universitaire de Nice, Nice, France; Laboratoire de génétique des tumeurs solides-Institute for Research on Cancer and Aging of Nice (IRCAN)-INSERM U1081-CNRS UMR 7284-Université de Nice-Sophia-Antipolis, Nice, France., Department of Surgical Urology, North Hospital, Assistance-Publique-Marseille, Marseille, France., Service d'Urologie, Hôpital Sainte Musse, Toulon, France., Aix-Marseille University, Marseille, France., Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France., Nuclear Medicine Department, North Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France., Centre Azuréen de Cancérologie, Mougins, France., Service de Radiothérapie, Ramsay Générale de Santé, Hôpital Privé Clairval, Marseille, France., Nuclear Medicine Department, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France., Department 2 of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France. Electronic address: .