Its application is important in considering patients for radical salvage prostatectomy (SRP) in patients failing radiation therapy (XRT) for localized CaP. 11C-PET/CT is normally considered for the detection of systemic CaP spread and there is limited experience with regard to the sensitivity of C-PET/CT to detect locally recurrent CaP following XRT. They sought to analyze the sensitivity of C-PET/CT to diagnose CaP and extra- and intraprostatic extension. A total of 45 patients with the suspicion of locally recurrent CaP underwent 12-core transrectal ultrasound-guided biopsy of the prostate, C-PET/CT, bone scan and radical salvage prostatectomy. Imaging studies were correlated with pathologic findings of the prostate biopsy and the radical prostatectomy specimens.
The mean preoperative serum PSA was 7.8ng/ml, and the mean biopsy Gleason score was 5.6. The prostate biopsy was positive in 37/45 (82.2%) patients whereas 8/45 (17.8%) had a negative biopsy despite positive PET/CT findings. PET/CT was positive with 1-3 intraprostatic cancer foci in 45/45 patients. Radical prostatectomy specimens identified locally recurrent CaP in 44/45 (97.8%). One patient turned out to have pT0pN0 disease despite increasing PSA. PET/CT identified 1, 2, and > 2 intraprostatic cancer foci of significant volume in 23 (51.1%), 13 (28.9%) and 9 (20%) patients, respectively. Sensitivity to detect intraprostatic, pathologically proven CaP foci is 95.6%, which is significantly superior to the biopsy results. There was a high correlation between the PET/CT results and the final histology of the radical prostatectomy specimens.
Presented by Axel Heidenreich, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.