Page 30 - Towards personalized therapy for metastatic prostate cancer: technical validation of [18F]fluoromethylcholine

Chapter 2
In the present study we investigated whether time-trends of enhanced [18F]FCH uptake in lymph nodes can help to discriminate between benign and malignant sites, and we explored whether single time point SUV measurements may also suffice.
MATERIALS AND METHODS
Patients
Formal ethical approval for performing this retrospective study was obtained from the Medical Ethics Committee of the VU University Medical Center, Amsterdam, the Netherlands (approval date June 2012, reference 2012/254). This approval states that written informed consent from participants is wavered since the study does not fall within the scope of the Medical Research Involving Human Subjects Act (section 16.2 WMO, 26th February 1998).
We retrospectively studied [18F]FCH PET/CT scans of 66 consecutive patients with prostate cancer (median age, 63 years; range, 50-80 years), performed at the VU University Medical Center, Amsterdam, The Netherlands, between January 2009 and March 2011. Three main clinical indications (I) for PET/CT were: I1. PSA relapse in previously treated PC (n=39); I2. newly diagnosed PC (n=16) and I3. staging of patients with suspected oligometastases (typically skeletal, identified with other imaging modalities), in newly diagnosed or already treated PC (n=11).
Patient characteristics [age, Gleason score (Gl), serum PSA at diagnosis and at the time of performing the PET/CT] were gathered, including the date and the type of previous therapy [e.g., radical prostatectomy (RP), external-beam radiation therapy (EBRT), brachytherapy (BT), pelvic lymph node dissection (PLND), anti-androgen therapy (ADT) or the combination of these].
Inclusion criteria were: dual-phase [18F]FCH PET/CT performed in patients with histopathologically proven PC; enhanced [18F]FCH uptake in any inguinal nodes and in pelvic LN with a short axis diameter ≥ 8 mm, visible at early and/ or late PET scan. Patients with multiple malignancies (e.g., one or more other types of carcinoma apart from the PC) were excluded.
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