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

To evaluate the effect of total PSA (tPSA) and PSA kinetics on the detection rates of C-11-Choline PET in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) or external beam radiotherapy (EBRT). We included 185 patients with BCR after RP (PSA > 0.2 ng/ml) or after EBRT (ASTRO definition). After injection of 400 MBq C-11-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. C-11-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. Total serum PSA and PSA velocity have significant effect on the detection rates of C-11-Choline PET/CT in men with a BCR after RP or EBRT.