[11C]Choline PET/CT for Targeted Salvage Lymph Node Dissection in Patients with Biochemical Recurrence after Primary Curative Therapy for Prostate Cancer

Introduction: In this prospective study we set out to investigate the diagnostic value of [11C]choline-PET/CT in patients with suspected lymph node metastases before salvage lymph node dissection. Patients and Methods: 15 consecutive patients with rising PSA underwent [11C]choline-PET/CT and consecutive open salvage pelvic/retroperitoneal extended lymph node dissection due to uptake of [11C]choline in at least 1 lymph node. Mean age was 62.1 (range 53–73). Results: [11C]choline-PET/CT results were compared with the histopathology reports and clinical follow-up (mean 13.7 months, range 6–24). Mean time to progression was 23.6 months (range 4–81). [11C]choline uptake was observed in nodes along the external and internal and common iliac arteries and in the paraaortic region. A positive histology was reported in 8/15 patients. Only one patient had a PSA nadir of <0.1 ng/ml after salvage surgery. Another patient had stable disease with a PSA of 0.5 ng/ml. Three patients developed bone metastases during follow-up. Conclusions: This interim analysis indicates that [11C]choline-PET/CT may be a useful technique in detection of lymph node metastases when rising PSA occurs after definite prostate cancer therapy. The presented cohort is limited in size, but there is still strong evidence that the patients benefit from [11C]choline-PET/CT and consecutive salvage lymph node dissection is rather small.

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