Role of 18F-Choline PET/CT in the Initial Staging of High Risk Prostate Cancer and Comparison with Conventional Imaging Techniques

• Raquel Sopeña Sutil ^[1] ; Adolfo Gómez Grande ^[2] ; Alejandro González Díaz ^[1] ; Julio Téigel Tobar ^[1] ; María Ángeles Cabeza Rodríguez ^[3] ; Enrique González Billalabeitia ^[4] ; Alfredo Rodríguez Antolín ^[1]
  1. [1] Urology Department, 12 de Octubre University Hospital, Madrid
  2. [2] Nuclear Medicine Department, 12 de Octubre University Hospital, Madrid
  3. [3] Radiation Oncology Department, 12 de Octubre University Hospital, Madrid
  4. [4] Medical Oncology Department, 12 de Octubre University Hospital, Madrid

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• Localización: Archivos españoles de urología, ISSN 0004-0614, Tomo 75, Nº. 8, 2022, págs. 684-692
• Idioma: español
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• Resumen

  • Objective: To assess the diagnostic accuracy of 18F-Choline PET/CT in the initial staging of high-risk prostate cancer (PC), and to compare it with conventional imaging techniques and to assess the changes in therapeutic attitude derived from its results.

    Secondary Objectives: To assess the concordance between 18F-Choline PET/CT and conventional study and to find related prognostic factors.

    Material and Methods: Retrospective observational study of 78 patients with high-risk PC undergoing 18F-Choline PET/CT after conventional initial staging (CT + BS). Sensitivity, specificity and predictive values of 18F-Choline PET/CT and CT + BS were calculated. The golden standard was histological result or follow-up. Tumor characteristics were collected and univariate and multivariate analyzes were performed.

    Results: The median age was 67 years old and mean PSA was 42.39 ng/mL. The sensitivity, specificity and NPV in global initial staging for PET/CT 18F-Choline and conventional imaging were: 92.9% vs 38.5%, 83.3% vs 42.3%, and 90.9% vs 40.7%, respectively. Lymph node staging: sensitivity 96.3% vs 61.5% and specificity 80% vs 76%, respectively. Bone staging: sensitivity 91.7% vs 21.4% and specificity 97.4% vs 83.8%, respectively. There was agreement in 25 patients (32%) (p = 0.004), Kappa index 0.134 (p = 0.011). The treatment was modified in 47.4% patients. PSA, PSADT% positive cores and cT were related to PET results. PSA level <8.9 ng/mL was considered an independent protective factor for positive PET (OR 0.03) (95% CI: 0.002-0.435, p 0.010).

    Conclusions: 18F-Choline PET/CT seems to be superior to CT + BS for initial staging in high-risk PC. It could be considered because its results can change the treatment decision in almost half of the patients.