PET/TC con Colina nel tumore della prostatavecchiosito.istitutotumori.mi.it/istituto/documenti/attivita/... · PET/TC con Colina nel tumore della prostata M Picchio Istituto Scientifico

PET/TC con Colina nel tumore della prostata

M Picchio Istituto Scientifico San Raffaele, Milano

Grand Round del Programma Prostata

INT, Milano 12 Aprile 2010

F]FDG PET [11C]Colina PET

Fegato

Rene destro

Renesinistro

Stomaco

Pancreas

PET/CT in prostate PET/CT in prostate cancercancer

[[1818F]FDG:F]FDG:-- UrinaryUrinary secretionsecretion-- Low Low glucoseglucose metabolismmetabolism in prostate in prostate cancercancer

[[1111C]Choline:C]Choline:-- Negligible urinary secretionNegligible urinary secretion-- Physiological prostate uptake Physiological prostate uptake

–– DiagnosisDiagnosis

–– InitialInitial StagingStaging

–– ReRe--stagingstaging

–– RT PlanningRT Planning

PET/CT in prostate PET/CT in prostate cancercancer: : clinicalclinical indicationindication






-- Physiological prostate uptakePhysiological prostate uptake

- Uptake in prostate cancer > uptake in benignprostate conditions (De Jong et al. 2002; Hara T et al. 2002, Martorana et al 2006, Scher et al. 2006, Reske et al. 2006) Overall sensitivity around 85%

- Uptake in prostate cancer = uptake in benignprostate conditions (Sutinen et al. 2003, Yoshida et al 2005; Farsad et al. 2005, Giovacchini et al. 2008)Overall sensitivity less than 45%

[[1111C]C]CholineCholine--PETPET: : diagnosisdiagnosis

Author Yr N. Pts %Sn

%Sp

%PPV

%NPV

Hara et al. 1998 10 - - - -

de Jong et al. 2002 30 100 - - -

Sutinen et al. 2004 19 100 - - -

Breeuwsma et al. 2005 18 100 - - -

Yamaguchi et al. 2005 20 100 - - -

Farsad et al. 2005 41 66 81 87 55

Reske et al. 2006 26 81 87 86 83

Martorana et al. 2006 43 66 83 - -

Scher et al. 2007 58 86 62 80 72

Testa et al. 2007 26 55 86 - -

Giovacchini et al. 2008 19 72 43 64 51

Li et al. 2008 49 90 86 83 92


[11C]Choline-PET/CT

Sensitivity 72%Specificity 43%PPV 64%NPV 51%Accuracy 60%

Good matching

Poor matching

R L

19 19 ptspts, 114 , 114 sextantssextantsSUV SUV >> 2,52,5


Giovacchini et al. Eur J Nucl Med Mol Imaging 2008

HyperplasiaHealthy Prostate cancer


HSR, Milan






[[1111C]CholineC]Choline--PET: N PET: N -- stagingstaging

[[1111C]CholineC]Choline--PET: N PET: N -- stagingstaging

[[1111C]CholineC]Choline--PET: staging of primary prostate cancerPET: staging of primary prostate cancer


%Sp

%PPV

%NPV

Kotzerke et al. 2000 12 - - - -

de Jong et al. 2003 67 80 96 - -

Martorana et al. 2006 43 22 - - -

Rinnab et al. 2007 55 36 - 73 -

Scher et al. 2007 58 82 - - -

Eschmann et al. 2007 42 97 76 - -

Schiavina et al. 2008 57 60 98 90 87

Luboldt et al. 2008 11 - - - -

[18F]FDG-PET [11C]Choline-PET

[[1111C]CholineC]Choline--PET: M PET: M -- stagingstaging

HSR, Milan







•• AccuracyAccuracy•• Relation Relation withwith PSA PSA •• Relation Relation withwith HormonalHormonal therapytherapy•• Flow chartFlow chart





[[1111C]CholineC]Choline--PET in RePET in Re--staging: accuracy staging: accuracy


%Sp

%PPV

%NPV

De Jong et al. 2003 36 38-78 - - -

Picchio et al. 2003 100 47 - - -

Rinnab et al. 2007 50 95 40 86 67

Scattoni et al. 2007 25 64 90 86 72

Reske et al. 2008 49 73 88 92 61

Krause et al. 2008 63 - - - -

Schilling et al. 2008 10 - - - -

Tuncel et al. 2008 45 - - - -

Giovacchini et al. 2009 358 85 93 91 87

[11C]Choline-PET

[[1111C]CholineC]Choline--PET/CT: rePET/CT: re--stagingstaging

[11C]Choline-PET

[[1111C]CholineC]Choline--PET/CT: rePET/CT: re--stagingstaging

25 pts with PSA relapse (1.98 ng/ml; 0.23-23.12 ng/ml) after radical prostatectomy

Gold standard: Histology (surgical lymph-node dissection)

[[1111C]CholineC]Choline--PET/CT: N PET/CT: N -- rere--stagingstaging

Per patient(n = 25)

Per lesions(n = 63)

Sensitivity (%) 100% 64%

Specificity (%) 66% 90%

PPV (%) 90% 86%

NPV (%) 100% 72%

Accuracy (%) 92% 77%

Scattoni et al. European Urology 2007


Per patient(n = 25)

Per lesions(n = 63)



PPV (%) 90% 86%

NPV (%) 100% 72%




Per patient(n = 25)

Per lesions(n = 63)



PPV (%) 90% 86%

NPV (%) 100% 72%







- 358 pts with increased PSA (3.77ng/ml ± 6.94) after radicalprostatectomy

- [11C]choline PET/CT was positive in 161/358 (45%)– 107/161 (66%) in lymph nodes– 55/161 (34%) in the prostatic bed– 46/161 (28%) in the skeleton

PET/CT (+) PET/CT (-) PPSA (ng/mL) 6.3 ± 8.9 1.6 ± 3.1 < 0.001

0

10

20

30

40

50

60

70

80

90

100

7%(4/57)

22%(10/45)

29%(10/34) 23%

(6/26)

39%(23/59)

44%(19/43)

49%(21/43)

77%(20/26)

84%(32/38)

88%(28/32)

.2-.4 1-1.5 2-3 >10.4-.6 .6-.8 .8-1 1.5-2 3-5 5-10

PSA (ng/mL)

Posi

tive

Cho

line

PET/

CT

(%)

18%(30/162)


[[1111C]CholineC]Choline--PET/CT: Relation with PSAPET/CT: Relation with PSA

Author N. Pts Tracer D.R.Low PSA

D.R.Intermediate

PSA

D.R.High PSA

Krause et al. 2008

63 11C-Chol 36% (<1 ng/ml)

43%(1 - 2 ng/ml)

62%(2 - 3 ng/ml)

73% (>3 ng/ml)

Pelosi et al. 2008

56 18F-Chol 20%(<1 ng/ml)

44%(1 - 5 ng/ml)

81(>5 ng/ml)

Giovacchini etal. 2009

358 11C-Chol 18% (<1 ng/ml)

46%(1 - 3 ng/ml)

82%(>3 ng/ml)

[[1111C]CholineC]Choline--PET/CT: Relation with PSA PET/CT: Relation with PSA (Detection rate)(Detection rate)

- 170 prostatectomised pts

- Median PSA was 1.25 ng/ml (range: 0.23–48.6 ng/ml)

- Median PSADT was 7.0 mo (range: 0.97–45.3 mo)

- [11C]choline PET/CT was positive in 75 of 170 patients (44%)

- Multivariate logistic regression showed that high PSA and short PSADT were significant (P < 0.05) predictors of positive [11C]choline PET/CT

Percent of patients with positive [11C]choline PET/CT:

27% for PSADT >6 mo

61% for PSADT between 3 and 6 mo

81% for PSADT <3 mo

17% -

6% 24%

3%

54% Like PSA, PSADT is an independent predictor of [11C]choline PET/CT.

[11C]choline PET/CT is very sensitive to PCa tumor growth, as reflected by PSA kinetics.

PSADT should be taken into account by physicians when referring PCa patients to [11C]choline PET/CT.




SUVmax = 4.5PSA: 20.0 ng/ml

SUVmax = 1.8PSA: 3.3 ng/ml

Prostate cancerPre e post treatment with Bucalutamide (150 mg/die)

[[1111C]CholineC]Choline--PET/CT: Relation with hormonal therapyPET/CT: Relation with hormonal therapy



[[1111C]CholineC]Choline--PET/CT: Relation with hormonal therapyPET/CT: Relation with hormonal therapy




HSR Milan

Local recurrence

LN

M

[[1111C]CholineC]Choline--PET/CT: total body studyPET/CT: total body study

+ -

SpecificTherapy

MR / TR Echo

+ -

Follow-up

[[1111C]CholineC]Choline--PET/CTPET/CT

SpecificTherapy

[[1111C]CholineC]Choline--PET/CT: FlowPET/CT: Flow--chartchart

ProstatectomisedProstatectomised Pt with PSA increasePt with PSA increase





PET in prostate PET in prostate cancercancer: : clinicalclinical indicationindication

[11C]Choline-PET/CT: RT planning

Per patient(n = 25)

Per lesions(n=63)



PPV (%) 90% 86%

NPV (%) 100% 72%




PET/CT1PSA1: <0.01 ng/mL

PET/CT0PSA0: 2.58 ng/mL

11C-Choline PET/CT study CMR


11C-Choline PET/CT study



11C-Choline PET/CT study PMR




11C-Choline PET/CT study CMR

PET/CT0

11C-Choline PET/CT study

PET/CT0 PET/CT1

11C-Choline PET/CT study PMR and M

–– DiagnosisDiagnosis: : newnew ligandsligands

–– InitialInitial StagingStaging: : toto bebe testedtested and validate and validate forfor N N stagingstaging

–– ReRe--stagingstaging and followand follow--upup: : 1) [1) [1111C]C]cholinecholine isis indicatedindicated (N and M)(N and M)2) PSA: 2) PSA: DependentDependent (18% in (18% in ptspts withwith PSA PSA < 1 ng/ml< 1 ng/ml))3) 3) HormonalHormonal therapytherapy: No : No dependencydependency4) Flow chart4) Flow chart

–– RT Planning (BTV):RT Planning (BTV):1) New 1) New ligandsligands forfor primaryprimary treatment (BTV)treatment (BTV)2) 2) RoleRole in in guidingguiding specificspecific treatmentstreatments

[[1111C]C]CholineCholine--PETPET in prostate in prostate cancercancer: : ConclusionConclusion

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PET/TC con Colina nel tumore della prostatavecchiosito.istitutotumori.mi.it/istituto/documenti/attivita/... · PET/TC con Colina nel tumore della prostata M Picchio Istituto Scientifico