PET/CT com Fluorocolina‐F18 no estadiamento inicial do carcinoma da próstata
DOI:
https://doi.org/10.24915/aup.33.3.34Palavras-chave:
Fluorocolina, Neoplasias da próstata, Radiofármacos, Tomografia por emissão de positrõesResumo
Objetivo
Na avaliação do carcinoma da próstata são habitualmente utilizados nomogramas clínicos para prever a probabilidade de disseminação linfática e extra ganglionar. Esses nomogramas podem sugerir a presença e a extensão desta neoplasia, mas não permitem a distinção clara entre doença loco regional e à distância. Pretendeu‐se, com este trabalho, avaliar a utilidade da tomografia por emissão de positrões/tomografia computorizada (PET/CT) com Fluorocolina‐F18 (FCH‐F18) na orientação de doentes com o diagnóstico inicial de carcinoma da próstata e estadiados por esta técnica imagiológica.
Material e métodos
Foram revistos os processos clínicos de 39 doentes com carcinoma da próstata que realizaram PET/CT com FCH‐F18 para estadiamento inicial, entre novembro de 2010 e abril de 2015. Destes, 20 doentes foram excluídos por terem iniciado hormonoterapia. Nos restantes 19 doentes, foi avaliado o desempenho da PET/CT com FCH‐F18 para deteção de metastização ganglionar através do cálculo dos valores de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acuidade diagnóstica. Seis doentes realizaram linfadenectomia pélvica (total de 69 gânglios), permitindo confirmação histológica. Quando não existia confirmação histológica, os achados da PET/CT com FCH‐F18 (total de 30 gânglios e 3 casos de metastização óssea) foram correlacionados com os valores do antigénio prostático específico (PSA) e com as informações de várias modalidades imagiológicas, como CT, cintigrafia óssea, ressonância magnética (RM), PET/CT com Fluoreto de Sódio‐F18 (FNa‐F18) e PET/CT com FCH‐F18 de controlo.
Resultados
Os valores de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acuidade diagnóstica para deteção de metastização ganglionar foram, respetivamente, 96,8%, 80,9%, 69,8%, 98,2% e 85,8%. Na nossa amostra, esta técnica identificou metástases, ganglionares extrapélvicas ou ósseas em 5 doentes (26,3%) com implicações na abordagem terapêutica. Mostrou captação sugestiva de metastização óssea, corroborada por outros meios de diagnóstico e pelo seguimento, em 3 doentes, estes com PSA de 9,5±2,9ng/mL.
Conclusões
A PET/CT com FCH‐F18 é uma modalidade imagiológica de corpo inteiro e multiorgão que permite identificar, de modo global, os locais de doença, em doentes com carcinoma da próstata. Neste estudo, a PET/CT com FCH‐F18 apresentou bons resultados quando utilizada no processo de estadiamento inicial destes doentes. Salienta‐se a sua capacidade para deteção de doença à distância, nomeadamente óssea, mesmo com PSA<20ng/mL.
Downloads
Referências
2. Kent C. Regulation of phosphatidylcholine biosynthesis. Prog Lipid Res. 1990;29(2):87-105.
3. Fox JJ, Schöder H, Larson SM. Molecular imaging of prostate cancer. Curr Opin Urol. 2012;22(4):320-7.
4. Ceci F, Castellucci P, Graziani T, Schiavina R, Brunocilla E, Mazzarotto R, et al. 11C-choline PET/CT detects the site of relapse in the majority of prostate cancer patients showing biochemical recurrence after EBRT. Eur J Nucl Med Mol Imaging. 2014;41(5):878-86.
5. Kwee SA, Coel MN, Lim J, Ko JP. Prostate cancer localization with 18fluorine fluorocholine positron emission tomography. J Urol. 2005;173(1):252-5.
6. Farsad M, Schwarzenböck S, Krause BJ. PET/CT and choline: Diagnosis and staging. Q J Nucl Med Mol Imaging.
2012;56(4):343-53.
7. Xie W, Tan AE, Cheng C, Whatt AG. Occult prostate cancer detected with 18F-fluorocholine positron emission
tomography/computed tomography. World J Nucl Med. 2014;13(3):205-8.
8. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65(1):124-37.
9. Abern MR, Terris MK, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, et al. The impact of pathologic staging on the long-term oncologic outcomes of patients with clinically high-risk prostate cancer. Cancer. 2014;120(11):1656-62.
10. Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: The essential importance of percentage of positive cores. Eur Urol. 2012;61(3):480-7.
11. Abuzallouf S, Dayes I, Lukka H. Baseline staging of newly diagnosed prostate cancer: A summary of the literature. J Urol. 2014;171:2122-7.
12. Hricak H, Choyke P, Eberhardt S, Leibel S, Scardino P. Imaging prostate cancer: A multidisciplinary prespective. Radiology. 2007;243:28-53.
13. Murphy G, Haider M, Ghai S, Sreeharsha B. The expanding role of MRI in prostate cancer. AJR Am J Roentgenol. 2013;201(6):1229-38.
14. Heesakkers RA, Hövels AM, Jager GJ, van den Bosch HC, Witjes JA, Raat HP, et al. MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: A prospective multicohort study. Lancet Oncol. 2008;9(9):850-6.
15. Kitajima K, Murphy RC, Nathan MA, Froemming AT, Hagen CE, Takahashi N, et al. Detection of recurrent prostate cancer after radical prostatectomy: Comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil. J Nucl Med. 2014;55(2):223-32.
16. Brenot-Rossi I. Focus: Prostate cancer and PET-choline. Prog Urol. 2014;24(1):3-8.
17. Gandaglia G, Abdollah F, Schiffmann J, Trudeau V, Shariat SF, Kim SP, et al. Distribution of metastatic sites in patients with prostate cancer: A population-based analysis. Prostate. 2014;74(2):210-6.
18. McMurtry CT, McMurtry JM. Metastatic prostate cancer: Complications and treatment. J Am Geriatr Soc.
2003;51(8):1136-42.
19. Poulsen MH, Petersen H, Høilund-Carlsen PF, Jakobsen JS, Gerke O, Karstoft J, et al. Spine metastases in prostate cancer: Comparison of technetium-99m-MDP whole-body bone scintigraphy, [(18) F]choline positron emission tomography(PET)/computed tomography (CT) and [(18) F]NaF PET/CT. BJU Int. 2014;114(6):818-23.
20. Wondergem M, van der Zant FM, van der Ploeg T, Knol RJ. A literature review of 18F-fluoride PET/CT and 18F-choline or 11C-choline PET/CT for detection of bone metastases in patients with prostate cancer. Nucl Med Commun. 2013;34(10):935-45.
21. Vali R, Loidl W, Pirich C, Langesteger W, Beheshti M. Imaging of prostate cancer with PET/CT using (18)F-Fluorocholine. Am J Nucl Med Mol Imaging. 2015;5(2):96-108.
22. Cimitan M, Bortolus R, Morassut S, Canzonieri V, Garbeglio A, Baresic T, et al. [18F]fluorocholine PET/CT imaging for the detection of recurrent cancer at PSA relapse: Experience in 100 consecutive patients. Eur J Nucl Med Mol Imaging. 2006;33:1387-98.
23. Schmid DT, John H, Zweifel R, Cservenyak T, Westera G, Goerres GW, et al. Fluorocholine PET/CT in patients with prostate cancer: Initial experience. Radiology. 2005;235:623-8.
24. Beheshti M, Imamovic L, Broinger G, Vali R, Waldenberger P, Stoiber F, et al. [18F]choline PET/CT in the preoperative staging of prostate cancer in patients with intermediate or high risk of extracapsular disease: A prospective study of 130 patients. Radiology. 2010;254:925-33.
25. Vargas HA, Grimm J, F Donati O, Sala E, Hricak H. Molecular imaging of prostate cancer: Translating molecular
biology approaches into the clinical realm. Eur Radiol. 2015;25(5):1294-302.
26. Jadvar H, Desai B, Ji L, Conti PS, Dorff TB, Groshen SG, et al. Baseline 18F-FDG PET/CT parameters as imaging biomarkers of overall survival in castrate-resistant metastatic prostate cancer. J Nucl Med. 2013;54(8):1195-201.
27. Bouchelouche K, Turkbey B, Choyke PL. Advances in imaging modalities in prostate cancer. Curr Opin Oncol.
2015;27(3):224-31.
28. Sankineni S, Brown AM, Fascelli M, Law YM, Pinto PA, Choyke PL, et al. Lymph node staging in prostate cancer. Curr Urol Rep. 2015;16(5):30.
29. Sharma S. Imaging and intervention in prostate cancer: Current perspectives and future trends. Indian J Radiol Imaging. 2014;24(2):139-48.
30. Lecouvet FE, Lhommel R, Pasoglou V, Larbi A, Jamar F, Tombal B. Novel imaging techniques reshape the landscape in high-risk prostate cancers. Curr Opin Urol. 2013;23(4):323-30.
31. Evangelista L, Cimitan M, Zattoni F, Guttilla A, Saladini G. Comparison between conventional imaging (abdominal-pelvic computed tomography and bone scan) and [(18)F]choline positron emission tomography/computed tomography imaging for the initial staging of patients with intermediate- to high-
-risk prostate cancer: A retrospective analysis. Scand J Urol. 2015:1-9.
32. Abuzallouf S, Dayes I, Lukka H. Baseline staging of newly diagnosed prostate cancer: A summary of the literature. J Urol. 2004;171 6 Pt 1:2122-7.
33. Schiavina R, Scattoni V, Castellucci P, Picchio M, Corti B, Briganti A, et al. 11C-choline positron emission tomography/ computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: Comparison with clinical staging nomograms. Eur Urol. 2008;54(2):392-401.
34. De Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJ. Preoperative staging of pelvic lymph nodes in prostate cancer by 11C-choline PET. J Nucl Med. 2003;44(3):331-5.
35. Poulsen MH, Bouchelouche K, Gerke O, Petersen H, Svolgaard B, Marcussen N, et al. [18F]-fluorocholine positron-emission/computed tomography for lymph node staging of patients with prostate cancer: Preliminary results of a prospective study. BJU Int. 2010;106(5):639-43, discussion 44.
36. Beheshti M, Vali R, Waldenberger P, Fitz F, Nader M, Loidl W, et al. Detection of bone metastases in patients with prostate cancer by 18F fluorocholine and 18F fluoride PET-CT: A comparative study. Eur J Nucl Med Mol Imaging. 2008;35(10):1766-74.
37. McCarthy M, Siew T, Campbell A, Lenzo N, Spry N, Vivian J, et al. 18F-Fluoromethylcholine (FCH) PET imaging in patients with castration-resistant prostate cancer: Prospective comparison with standard imaging. Eur J Nucl Med Mol Imaging. 2011;38(1):14-22.
38. Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid 68Ga-PSMA-ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015.
39. Kim YI, Cheon GJ, Paeng JC, Cho JY, Kwak C, Kang KW, et al. Usefulness of MRI-assisted metabolic volumetric parameters provided by simultaneous (18)F-fluorocholine PET/MRI for primary prostate cancer characterization. Eur J Nucl Med Mol Imaging. 2015.
40. Eiber M, Nekolla SG, Maurer T, Weirich G, Wester HJ, Schwaiger M. (68)Ga-PSMA PET/MR with multimodality image analysis for primary prostate cancer. Abdom Imaging. 2014.
