Original Study ( 11 C)Choline PET/CT Impacts Treatment Decision Making in Patients With Prostate Cancer Referred for Radiotherapy

Abstract A modi fication of therapy in light of the [ 11 C]cholineepositron emission tomography/computed tomography(cho-PET/CT) assessment was found in approximately 30% of patients with prostate cancer in our study. Thereported outcomes are put forward to support the important role of cho-PET/CT as a steering factor in thechoice of the most appropriate therapeutic approach for patients with cancer.Background: The purpose of our study was to analyze the role of [ 11 C]cholineepositron emission tomography/computedtomography(cho-PET/CT)inthemanagementofpatientswithcancerreferredforradiotherapy. Patients andMethods: Inclusion criteria for this retrospective study were (1) presence of prostate cancer, (2) referral for firstradiotherapy course (for primary or recurrent tumor) between February 2007 and July 2010, and (3) performance of cho-PET/CT. All cho-PET/CT scans were classified according to whether they were positive in the prostate/prostate bed (T),pelvic lymph nodes (N), and distant metastases (M) or negative. Therapeutic strategy based on the cho-PET/CTevaluation was compared with the strategy that would have been proposed had cho-PET/CT imaging not beenavailable, following international and national prostate cancer guidelines. Results: Eighty-two cho-PET/CT scansperformed in 74 patients were analyzed. Cho-PET/CT was positive in 49 studies (60%): T only in 22 (45% of all positivestudies); N only in 4 (8%); T in combination with N in 3 (6%); and M in combination with T or N, or both, in 16 (33%).Treatment after positive cho-PET/CT examination included radiotherapy • androgen deprivation (29 patients), surgery• radiotherapy (6 patients), androgen deprivation only (8 patients), and other treatment (6 patients). In 22 cases, cho-PET/CT (27%) altered the treatment approach compared with the treatment that would have been adopted in theabsence of cho-PET/CT analysis. Conclusion: Cho-PET/CT is valuable in de fining the extent of disease and supportingtherapeutic decisions in the management of prostate cancer. The therapeutic strategy turned out to be in fluenced bycho-PET/CT imaging in about one third of the patients included in this study.Clinical Genitourinary Cancer, Vol.