Journal article
11C-Acetate PET/CT before Radical Prostatectomy: Nodal Staging and Treatment Failure Prediction
The Journal of nuclear medicine (1978), Vol.54(5), pp.699-706
05/2013
DOI: 10.2967/jnumed.112.111153
PMCID: PMC3787881
PMID: 23471311
Abstract
Despite early detection programs, many patients with prostate cancer present with intermediate-or high-risk disease. We prospectively investigated whether C-11-acetate PET/CT predicts lymph node (LN) metastasis and treatment failure in men for whom radical prostatectomy is planned. Methods: 107 men with intermediate-or high-risk localized prostate cancer and negative conventional imaging findings underwent PET/CT with C-11-acetate. Five underwent LN staging only, and 102 underwent LN staging and prostatectomy. PET/CT findings were correlated with pathologic nodal status. Treatment-failure-free survival was estimated by the Kaplan-Meier method. The ability of PET/CT to predict outcomes was evaluated by multivariate Cox proportional hazards analysis. Results: PET/CT was positive for pelvic LN or distant metastasis in 36 of 107 patients (33.6%). LN metastasis was present histopathologically in 25 (23.4%). The sensitivity, specificity, and positive and negative predictive values of PET/CT for detecting LN metastasis were 68.0%, 78.1%, 48.6%, and 88.9%, respectively. Treatment failed in 64 patients: 25 with metastasis, 17 with a persistent postprostatectomy prostate-specific antigen level greater than 0.20 ng/mL, and 22 with biochemical recurrence (prostate-specific antigen level > 0.20 ng/mL after nadir) during follow-up for a median of 44.0 mo. Treatment-failure-free survival was worse in PET-positive than in PET-negative patients (P < 0.0001) and in those with false-positive than in those with true-negative scan results (P < 0.01), suggesting that PET may have demonstrated nodal disease not removed surgically or identified pathologically. PET positivity independently predicted failure in preoperative (hazard ratio, 3.26; P < 0.0001) and postoperative (hazard ratio, 3.07; P = 0.0001) multivariate models. Conclusion: In patients planned for or completing prostatectomy, C-11-acetate PET/CT detects LN metastasis not identified by conventional imaging and independently predicts treatment-failure-free survival.
Details
- Title: Subtitle
- 11C-Acetate PET/CT before Radical Prostatectomy: Nodal Staging and Treatment Failure Prediction
- Creators
- Mohammed Haseebuddin - Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MOFarrokh Dehdashti - Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MOBarry A Siegel - Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MOJingxia Liu - Division of Biostatistics, Washington University School of Medicine, St. Louis, MOElizabeth B Roth - Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MOKenneth G Nepple - Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MOCary L Siegel - Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MOKeith C Fischer - Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MOAdam S Kibel - Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MOGerald L Andriole - Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MOTom R Miller - Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
- Resource Type
- Journal article
- Publication Details
- The Journal of nuclear medicine (1978), Vol.54(5), pp.699-706
- DOI
- 10.2967/jnumed.112.111153
- PMID
- 23471311
- PMCID
- PMC3787881
- ISSN
- 0161-5505
- eISSN
- 1535-5667
- Grant note
- R01 CA101734 || CA / National Cancer Institute : NCI
- Language
- English
- Date published
- 05/2013
- Academic Unit
- Urology
- Record Identifier
- 9984051703202771
Metrics
20 Record Views