A population-based study of the clinical utility of 18F–choline PET/CT for primary metastasis staging of high-risk prostate cancer

Abstract

Abstract Background The clinical utility of 18F–choline positron emission tomography fused with computed tomography (PET/CT) in all men with high-risk prostate cancer is still uncertain, because of selection of patients in previous studies. Prohibitive costs are one reason for PET/CT not being recommended for primary metastasis staging in European or American guidelines. The purpose of this retrospective study was to assess the clinical utility of in for primary metastasis staging in as complete a population as possible of men with high-risk prostate cancer. A secondary purpose was to evaluate whether a subgroup of these men could omit metastasis staging. Results In total 410 men were identified with high-risk prostate cancer. After exclusions, 317 men were initially considered for curative treatment; 213 (67%) had a choline PET/CT, with 43 men (20%) having positive findings. The risk of lymph node metastasis according to the Briganti nomogram showed a good discrimination between men with low and high risk of positive scans. Among the 35% of men with <20% risk according to the nomogram, only 1% had a positive scan, compared to 30% positive scans among the men who had higher risk. Conclusion 18F–choline PET/CT detects suspected metastases in one fifth of men with high-risk prostate cancer and should be considered for routine use. For men with <20% risk of metastasis according to the Briganti nomogram, imaging for metastasis staging might be omitted.

Keywords

• Prostate cancer
• Pet/ct
• Bone scintigraphy
• Primary metastasis staging