Impact of total PSA, PSA doubling time and PSA velocity on detection rates of 11C-Choline positron emission tomography in recurrent prostate cancer

Maxim Rybalov*, Anthonius J. Breeuwsma, Anna M. Leliveld, Jan Pruim, Rudi A. Dierckx, Igle J. de Jong

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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PURPOSE: To evaluate the effect of total PSA (tPSA) and PSA kinetics on the detection rates of (11)C-Choline PET in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) or external beam radiotherapy (EBRT).

METHODS: We included 185 patients with BCR after RP (PSA >0.2 ng/ml) or after EBRT (ASTRO definition). After injection of 400 MBq 11C-Choline i.v., a scan was made using the ECAT HR + PET camera with CT fusion images or Siemens mCT PET/CT. Biopsy-proven histology, confirmative imaging (CT or bone scan) and/or clinical follow-up (PSA) were used as composite reference. Statistical analysis was performed using PASW Statistics 18.

RESULTS: 11C-Choline PET was positive in 124/185 cases (65%) (in 22/61 (36%) after RP, 102/124 (82%) after EBRT). In 79 patients a local recurrence was identified, and 45 patients showed locoregional metastases on PET/CT. In 20 cases a proven false-negative PET scan was observed. Positive PET scans were confirmed by histology in 87/124 (70%) cases, by confirmatory imaging in 34/124 (28%) and by clinical follow-up after salvage treatment in 3 (2%) cases. The ROC analysis to detect a recurrence showed significant difference in area under the curve (AUC) of tPSA 0.721(p < 0.001) and PSA velocity 0.730 (p < 0.001). PSA doubling time showed no significant difference with an AUC of 0.542 (p = 0.354). Detection rates are <50% in tPSA <2 ng/ml and/or PSA velocity <1 ng/ml/year.

CONCLUSIONS: Total serum PSA and PSA velocity have significant effect on the detection rates of 11C-Choline PET/CT in men with a BCR after RP or EBRT.

Original languageEnglish
Pages (from-to)319-323
Number of pages5
JournalWorld journal of urology
Issue number2
Publication statusPublished - Apr-2013


  • Aged
  • Carbon Radioisotopes
  • Choline
  • Disease Progression
  • Humans
  • Kallikreins
  • Male
  • Multimodal Imaging
  • Neoplasm Recurrence, Local
  • Positron-Emission Tomography
  • Prostate-Specific Antigen
  • Prostatectomy
  • Prostatic Neoplasms
  • Radiopharmaceuticals
  • Radiotherapy
  • Retrospective Studies
  • Sensitivity and Specificity
  • Time Factors
  • Tomography, X-Ray Computed
  • Tumor Markers, Biological

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