[F18]-fluoroethylcholine combined in-line PET-CT scan for detection of lymph-node metastasis in high risk prostate cancer patients prior to radical prostatectomy: Preliminary results from a prospective histology-based study

Steuber, T.; Schlomm, T.; Heinzer, H.; Zacharias, M.; Ahyai, S.; Chun, K.F.; Haese, A.; Klutmann, S.; Köllermann, J.; Sauter, G.; Mester, J.; Mikecz, P.; Fisch, M.; Huland, H.; Graefen, M.; Salomon, G.

doi:10.1016/j.ejca.2009.11.008

« Previous Next »European Journal of Cancer
Volume 46, Issue 2 , Pages 449-455, January 2010

[F¹⁸]-fluoroethylcholine combined in-line PET-CT scan for detection of lymph-node metastasis in high risk prostate cancer patients prior to radical prostatectomy: Preliminary results from a prospective histology-based study

T. Steuber
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Corresponding author: Tel.: +49 40 7410 51300; fax: +49 40 7410 51323.
T. Schlomm
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
H. Heinzer
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
M. Zacharias
- Department of Urology, University Hospital Hamburg-Eppendorf, Germany
S. Ahyai
- Department of Urology, University Hospital Hamburg-Eppendorf, Germany
K.F. Chun
- Department of Urology, University Hospital Hamburg-Eppendorf, Germany
A. Haese
- Department of Urology, University Hospital Hamburg-Eppendorf, Germany
S. Klutmann
- Department of Urology, University Hospital Hamburg-Eppendorf, Germany
J. Köllermann
- Department of Pathology, University Hospital Hamburg-Eppendorf, Germany
G. Sauter
- Department of Pathology, University Hospital Hamburg-Eppendorf, Germany
J. Mester
- Department of Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
P. Mikecz
- Nuclear Medicine Center, Radiochemistry Center, University of Debrecen, Hungary
M. Fisch
- Department of Urology, University Hospital Hamburg-Eppendorf, Germany
H. Huland
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
M. Graefen
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
G. Salomon
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

Received 16 June 2009; received in revised form 21 September 2009; accepted 12 November 2009. published online 07 December 2009.

Abstract

Purpose

To evaluate the diagnostic potential of PET/CT using ([F¹⁸]fluorethylcholine (FEC) for lymph node (LN) staging in high risk prostate cancer (PCa) patients prior to radical prostatectomy (RP).

Patients and methods

Twenty patients with localised PCa and ⩾20% LN risk according to a published nomogram were prospectively enrolled. FEC PET/CT was done minimum 14d after prostate biopsy. Afterwards, open RP and extended pelvic LN dissection (ePLND) were performed. Clinical stage, Prostate Specific Antigen (PSA) and biopsy Gleason Grading were assessed and histopathological evaluation of the RP-specimens and dissected LN has been performed. The results from PET/CT were compared with LN metastasis according to their anatomical site.

Results

Overall, 285 LN have been removed with a mean number of 15 nodes per patient (7–26). Of the 20 patients, 9 men were LN positive (45%), which corresponds to 31 positive LN with a mean size of 7mm (0.8–12mm). Dissection of the obturator fossa, external iliac artery/vein and internal iliac artery/vein revealed 36%, 48% and 16% of positive LN, respectively. FEC PET/CT did not detect one single positive LN, thus was false-negative in 31 metastasis and true negative in 254 LN.

Conclusion

Based on our results which confirmed experience from the previous studies, FEC PET/CT scan did not prove to be useful for LN staging in localised PCa prior to treatment and should thus not be applied if clinically occult metastatic disease is suspected.

Keywords: Prostate cancer, Lymph node metastasis, Staging, Imaging, PET-CT, Extended lymphadenectomy