11C-choline PET/CT identifies osteoblastic and osteolytic lesions in patients with metastatic prostate cancer - Abstract

AIM: The aim of this study was to compare 11C-choline PET/CT, prostate-specific antigen (PSA), PSA kinetics, and 11C-choline uptake in recurrent metastatic prostate cancer patients with osteoblastic and osteolytic bone metastases.

PATIENTS AND METHODS: We retrospectively analyzed 140 patients with the following criteria: (a) positive bone lesions identified with 11C-choline PET/CT and validated as true positive by histology (14.2%), correlative imaging (33.4%), or clinical follow-up (52.4%); (b) after radical prostatectomy (67.9%) or primary radiotherapy (22.1%); (c) proven biochemical relapse with rising PSA levels; (d) no chemotherapy, zoledronic acid, or palliative bone external beam radiation therapy previously administrated during biochemical relapse; and (f) asymptomatic for bone pain. Lesions were categorized as osteoblastic, osteolytic, or bone marrow lesions. Patients were divided into osteoblastic and osteolytic patient groups.

RESULTS: 11C-Choline PET/CT detected oligometastatic bone disease (1-3 lesions) in 98 (70%) of the 140 patients and multiple bone lesions in 42 (30%) of the 140 patients. By per-lesion analysis of 304 lesions, there were 184 osteoblastic, 99 osteolytic, and 21 bone marrow lesions.By per-patient analysis, 97 (69.3%) of the 140 patients were in the osteoblastic group, whereas 43 (30.7%) of the 140 patients were in the osteolytic group. Statistically significant differences in SUVmax (P < 0.001), fast PSA doubling time (P = 0.01), and PSA velocity (P = 0.01) were observed between osteoblastic (lower values) and osteolytic (higher values) groups. By multivariate analysis, fast PSA doubling time was a significant predictor for osteolytic lesions.

CONCLUSIONS: We demonstrated differences in PSA kinetics and SUVmax between osteolytic and osteoblastic lesions. 11C-Choline PET/CT may identify patients that could benefit from early targeted therapies, depending on the type of bone lesions expressed.

Written by:
Ceci F, Castellucci P, Graziani T, Schiavina R, Chondrogiannis S, Bonfiglioli R, Costa S, Virgolini IJ, Rubello D, Fanti S, Colletti PM.   Are you the author?
Service of Nuclear Medicine, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna Italy; Department of Nuclear Medicine, Medizinische Universität Innsbruck, Innsbruck, Austria; Department of Urology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna; Department of Nuclear Medicine and PET/CT Center, Santa Maria della Misericordia Hospital, Rovigo, Italy; Department of Radiology, University of Southern California, LAC + USC Medical Center, Los Angeles, CA.

Reference: Clin Nucl Med. 2015 May;40(5):e265-70.
doi: 10.1097/RLU.0000000000000783

PubMed Abstract
PMID: 25783519

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