| Objective Although 18F-FDG PET/CT has been widely used in various malignancies, it has false negative results to some extent for the detection of prostate cancer(PCa). Seeking different tracer to increase the overall sensitivity is what we strive for. The aim of this study was to evaluate the application value of using 11C-Choline (11C-CHO) and 18F-FDG PET/CT for the diagnosing and staging of PCa and detection recurrent ones.Materials and Methods Sixty-three patients with prostate lesion were included and examined with 11C-CHO and 18F-FDG PET/CT imaging sequentially. They were divided into two groups:1. cases of 47 without any therapy, male, age 47-96, PSA 2.00ng/ml-173.00ng/ml.16 of them underwent "C-CHO PET/CT imaging. PET results were evaluated by visual and semi-quantitative analysis. Measuring the maximum standardized uptake values (SUVmax) of the prostate lesions (target) and the muscles (non-target) and calculating their ratios (P/M). We investigated the correlations among the SUVmax, P/M and Prostatic specific antigen (PSA). SPSS17.0 statistical package was used to analyze in this study. p<0.05 was considered statistically significant.2.16 Patients who have accepted either surgery or maximum androgen blockade therapy were restaged.Results 25 prostate caner and 22 benign prostatic hyperplasia (BPH) patients in the first group.20 of them were proven by biopsy, others were proven by clinical follow up at least 1 year. The sensitivities, specificities, and accuracies of 18F-FDG, 11C-CHO PET/CT for the detection of prostate cancer were 76.0%,45.5%,65.9% and 80.0%,66.7%,62.5%. And 18F-FDG+11C-CHO PET/CT:sensitivities was 90%, specificities was 66.7%, and accuracies was 68.7%. (1) Semi-quantitative analysis: 18F-FDG, The mean values of SUVmax of PCa and BPH were 8.03±7.02 and 4.36±2.82, respectively. The statistical differences of SUVmax between them were significant (t=2.41, p=0.022). The mean values of P/M of PCa and BPH were10.24±8.10 and 6.19±2.63, respectively. The statistical differences of P/M between them were significant (t=2.36, p=0.025). 11C-CHO, The mean values of SUVmax, P/M of PCa and BPH were 7.11±2.59,4.12±0.59,12.15±5.21 and 6.25±2.26, respectively. The statistical differences of them were significant (t=3.50, p=0.005 and t=3.13,p=0.008). (2) Establishment of ROC curve, the area-under-curve value with 18F-FDG, 11C-CHO were 0.665 and 0.867, respectively. The optimal operating point value with them was 12.39 and 6.53, respectively. (3) The Clinical staging of PCa (Whitmore-Jewett):18F-FDG, The proportion of stage A, B, C, D in the 25 PCa were 4.0%,16.0%,12.0% and 68.0%, respectively. 11C-CHO, the number of stage B and C, D in the 10 PCa were 1 and 9. In the 25 patients, the metastasis including lymph node of abnormal and pelvic, bone, lung and adrenal were detected by PET/CT. (4) Correlation analysis:Positive correlations between CHO and FDG uptake were observed (SUVmax, r=0.670,p=0.004; P/M, r=0.607, p=0.013), but there were no significant differences. Positive correlations between the SUVmax and P/M ratios of each tracer and the PSA, there were no significant differences (SUVmax, r=0.379,p=0.148; P/M, r=0.360,p=0.171).2. There were 16 Patients who have accepted either surgery or maximum androgen blockade therapy.10 patients were detected with recurrent or metastasis, others were not detected with recurrent.Conclusion PET/CT is a valuable non-invasive imaging technology in the prostate cancer. 11C-CHO combined with 18F-FDG PET/CT not only increases the overall sensitivity for the detection of primary PCa, but also was a potentially useful for the staging, management and detection of recurrent of prostate cancer. And the parameter SUVmax and P/M appear to be useful in distinguishing between the benign and malignant of prostate diseases, but there was more reliable of the P/M with 11C-CHO than with 18F-FDG. Furthermore, a large sample of the comparison research was needed on the contrast of 11C-CHO and 18F-FDG PET/CT in prostate cancer. |
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