Salvage Treatment in Patients With Prostate Cancer Oligorecurrence: Impact of 18-F-Fluorocholine Positron Emission Tomography/Computed Tomography on Clinical Decision Making


      There is a growing interest in a new entity of patients with recurrent prostate cancer (rPCa) limited to a small number of active metastatic lesions: the oligometastatic/ oligorecurrent patients. These patients could eventually be managed by treating all the active lesions with local therapy. The objective of this study is to evaluate the clinical impact of 18-F-fluorocholine PET/CT (Ch-PET) on treatment management decisions in patients with recurrent prostate cancer after radical treatment.


      Between January 2013 and April 2015, sixty-nine consecutive patients have been prospectively studied. Primary radical approaches included radical prostatectomy +/- radiation therapy (RT) (54-pts), RT (44-pts) or cryotherapy (1-pts). All patients underwent a Ch-PET at the time of biochemical recurrence. The lower PSA threshold required to order a Ch-PET was 1 ng/mL. The effective clinical impact of Ch-PET on patient management was rated as major (change in therapeutic approach), minor (same treatment but modified therapeutic strategy) or none (no treatment or standard androgen deprivation therapy (ADT)).


      The median PSA doubling time, PSA velocity and PSA values before PET were 3.8 months (0.54-39), 0.34 ng/ml/mo (0-20.1) and 3 (1-128) ng/ml, respectively. Ch-PET was positive in 52 (75%) patients. Local recurrence was found in 10 patients (14.5%), nodal disease in 29 patients (42%), bone metastases in 7 patients (10.1%) and mixed recurrences in 6 patients (8.6%). Among the 52 patients with positive findings on Ch-PET, 42 (80.7%) patients received local treatment of the oligorecurrent sites (41 patients RT +/- ADT and 1 surgery), 2 (3.8%) patients underwent observation, 2 (3.8%) patients chemotherapy and 6 (11.5%) patients received standard ADT. Based on these results, the impact of Ch-PET was classified as major in 60.9% (42/69) of the patients, minor in 2.8% and none in 36.3% of patients.


      18-F-fluorocholine PET/CT in patients performed at a low PSA threshold can significantly impact on treatment management of oligorecurrent PCa, allowing salvage local treatments in a significant percentage of patients. Hence, it should be routinely adopted for restaging patients with rPCa.


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