Impact of [18F]F-choline PET/CT on the management of high-risk prostate cancer.

OBJECTIVE

To analyze the impact of [18F]F-Choline PET/CT findings on therapeutic management compared to conventional imaging techniques in the high-risk prostate cancer (PC) staging.

MATERIALS AND

METHODS

Observational, longitudinal and retrospective study including patients with high-risk PC who underwent a [18F]F-choline PET/CT after initial staging with conventional imaging techniques (bone scan and abdomen-pelvis CT) between January 2018 and December 2023. Findings were classified as limited disease (lymph node involvement in pelvis and/or axial skeleton) or extended disease (extrapelvic lymph node involvement, involvement of extra-axial skeleton and/or distant sites). Finally, the impact of the results on therapeutic management and on disease volume reclassification (CHAARTED criteria) was analyzed.

RESULTS

One hundred and nineteen patients were included (mean age: 68.43 ± 9.33 years, diagnostic prostate-specific antigen 64.22 ± 159.40 ng/mL). [18F]F-choline PET/CT was positive in 71.4% of patients (50.4% with limited disease and 21.0% with extended disease) versus 21.2% detected by conventional techniques (P < .001). Based on PET findings, 18% of patients had high-volume disease compared to 5% based on conventional imaging (P = .002). [18F]F-choline PET/CT findings led to a change in therapeutic management in 54 patients (45.4%). Among them, 11 (9.2%) received radiotherapy to the pelvic lymph nodes, 14 patients (11.8%) hormone therapy, 23 patients (19.3%) were candidates for therapy with new antiandrogens, and 6 cases (5%) received systemic chemotherapy.

CONCLUSION

[18F]F-choline PET/CT is superior to conventional imaging techniques in high-risk prostate cancer staging, detecting 18% of patients with high-volume disease and leading to a change in therapeutic management in 45% of cases. CRITICAL RELEVANCE STATEMENT: [18F]F-choline PET/CT is superior to conventional imaging techniques in high-risk prostate cancer staging.