Diagnostic Performance of [18F]Fluorocholine and [68Ga]Ga-PSMA PET/CT in Prostate Cancer: A Comparative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Study Agents
2.3. PET/CT Imaging and Evaluation
2.4. Statistics
3. Results
3.1. Study Cohort
3.2. Lesion Based Findings
3.3. Prostate, Prostate Bed, and Seminal Vesicles
3.4. Regional and Distant Lymph nodes
3.5. Skeletal Lesions
3.6. Organ Metastases
3.7. Patient Based Findings
3.7.1. TNM Staging
3.7.2. Discordant Lesions
3.7.3. Correlation of PET Positivity and PSA Value
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Modality | Anatomic Category | Overall Lesion Number | |||
---|---|---|---|---|---|
Prostate, Prostate Bed and Seminal Vesicles | Skeletal | Regional and Distant Lymph Nodes | Soft Tissue (Hepatic) | ||
[68Ga]Ga-PSMA PET/CT positive only | 1 (6.3%) | 9 (15.1%) | 17 (24.6%) | 3 (100%) | 30 (20.3%) |
[18F]Fluorocholine PET/CT positive only | 0 | 8 (13.3%) | 5 (7.3%) | 0 | 13 (8.8%) |
Positive on both modalities | 15 (93.7%) | 43 (71.6%) | 47 (68.1%) | 0 | 105 (70.9%) |
Total | 16 | 60 | 69 | 3 | 148 |
Anatomic Category | |||
---|---|---|---|
Modality | Prostate, Prostate Bed and Seminal Vesicles SUV Max (Mean ± SD) | Skeletal SUV Max (Mean ± SD) | Regional and Distant Lymph Nodes SUV Max (Mean ± SD) |
[68Ga]Ga-PSMA PET/CT | 14.6 ± 8.4 | 23.4 ± 16.9 | 20.3 ± 13.2 |
[18F]Fluorocholine PET/CT | 6.9 ± 3.4 | 10.8 ± 3.4 | 7.8 ± 4.1 |
p-value | 0.001 | <0.001 | <0.001 |
Patient Number | Referring Cause | PSA Level | Stage by [68Ga]Ga-PSMA PET/CT | Stage by [18F]Fluorocholine PET/CT |
---|---|---|---|---|
20 | restaging | 0.07 | N1M1b | N1 (false) |
3 | restaging | 0.35 | N1, stage IV | Complete remission (false) |
6 | staging | 21.4 | T2c, stage IIB | N1, stage IV (false inflammatory node) |
7 | restaging | 2.51 | N1 (false) | N1M1b |
Patient Number | Clinical History | Imaging Findings | Note |
---|---|---|---|
13 | Referred for Staging PSA = 61 Gleason score = 7 castration resistant (hormone therapy, chemotherapy, local radiation). | In Prostate bed and skeleton the [68Ga]Ga-PSMA PET/CT was the superior imaging modality. While variable pattern of imaging superiority was found in lymph nodes lesions, [18F]Fluorocholine PET/CT was prominent in some prominent nodes, even up to 60 mm in size. | Castration refractory prostate cancer and elevated PSA value not responding to conventional treatments; [18F]Fluorocholine PET/CT superiority may belong to dedifferentiating nodal metastases. |
6 | Referred for Staging PSA = 21.42 Gleason Score = 8 (TURP performed. After two months PSA reaches 0.17 in one year follow up). | In Prostate gland, [68Ga]Ga-PSMA PET/CT was the superior modality. No skeletal lesion detected. There is a solitary [18F]Fluorocholine positive node in right para-rectal space (measuring 5 mm, node SUV max 2.19). | PSA reached its nadir (0.17) after TURP and the node was assumed inflammatory pelvic node. By considering borderline radioactivity SUV max 2.19, we may avoid misinterpretation. |
Patient Number | Clinical History | Imaging Findings | Note |
---|---|---|---|
17 | Referred for Staging PSA = 81.17 Gleason Score = 7 | In Prostate bed and lymph nodes [68Ga]Ga-PSMA PET/CT was the superior imaging modality; While variable pattern of imaging superiority was found in skeletal lesions, [18F]Fluorocholine PET/CT was prominent in some skeletal lesions including small and negligible lesions in L2 vertebra(measured 10 mm) and left 8th rib (measured 8 mm) | [18F]Fluorocholine PET/CT superiority was only in few, small and sub-centimetric lesions may be due to significant [68Ga]Ga-PSMA uptake by larger metastases. |
29 | Referred for RestagingPSA = 19.3 Gleason Score = 8 Progressive disease | While variable pattern of imaging superiority was found in skeletal lesions, [18F]Fluorocholine PET/CT was prominent in some skeletal lesions including small and negligible lesions measuring up to 17 mm. | [18F]Fluorocholine PET/CT superiority was only in few, small and sub-centimetric lesions may be due to significant [68Ga]Ga-PSMA uptake by larger metastases. |
5 | Referred for Restaging PSA = 2078 Gleason score = 9 Castration resistant progressive disease (Xtandi, Zytiga, chemotherapy with Zyklen and Taxotere) | No prostate lesion or lymphatic involvement detected in the patient. Multiple bone lesions were noticed; all prominent in number and SUV (twice) in [18F]Fluorocholine PET/CT. | Castration refractory prostate cancer and elevated PSA value (2078) not responding to conventional treatments; [18F]Fluorocholine PET/CT superiority may be due to dedifferentiating metastases. |
7 | Referred for Restaging PSA = 2.51ng/mL previous PSA one month before was 5ng/mL Gleason score = 9 | No prostate bed or soft tissue involvement detected by the imaging modalities, The two lymph nodes detected were prominent in [68Ga]Ga-PSMA scan. Bone lesions (7 mm in T11 and 12 mm in T6 vertebra) were exclusively detected by [18F]Fluorocholine PET/CT and confirmed by MRI. | A pattern could not be supposed explaining small vertebral metastases exclusively found on [18F]Fluorocholine PET/CT (confirmed by MRI). |
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Paymani, Z.; Rohringer, T.; Vali, R.; Loidl, W.; Alemohammad, N.; Geinitz, H.; Langsteger, W.; Beheshti, M. Diagnostic Performance of [18F]Fluorocholine and [68Ga]Ga-PSMA PET/CT in Prostate Cancer: A Comparative Study. J. Clin. Med. 2020, 9, 2308. https://doi.org/10.3390/jcm9072308
Paymani Z, Rohringer T, Vali R, Loidl W, Alemohammad N, Geinitz H, Langsteger W, Beheshti M. Diagnostic Performance of [18F]Fluorocholine and [68Ga]Ga-PSMA PET/CT in Prostate Cancer: A Comparative Study. Journal of Clinical Medicine. 2020; 9(7):2308. https://doi.org/10.3390/jcm9072308
Chicago/Turabian StylePaymani, Zeinab, Taryn Rohringer, Reza Vali, Wolfgang Loidl, Nafiseh Alemohammad, Hans Geinitz, Werner Langsteger, and Mohsen Beheshti. 2020. "Diagnostic Performance of [18F]Fluorocholine and [68Ga]Ga-PSMA PET/CT in Prostate Cancer: A Comparative Study" Journal of Clinical Medicine 9, no. 7: 2308. https://doi.org/10.3390/jcm9072308