Detection of Oligometastatic recurrent PCa.

[pjoshea13]

New Italian study.

I imagine that some are here because primary treatment has failed, but the situation isn't yet clear. There is increasing acceptance of the oligometastatic concept - that men with a few mets might be treated & perhaps cured. But first, the mets have to be found - & discovered earl IMO.

In the study, using a choline PET scan: "One-hundred and ninety-three patients had a negative F-FCH PET/CT, whereas 131 (40.4%) had a positive scan. Of these latter patients, 35 had a significant F-FCH uptake in the prostatic fossae, 59 in the lymph nodes, and 37 in bone."

"In patients with early recurrence of PC, F-FCH PET/CT is able to detect {oligometastatic disease} in 40% of cases. This finding has an important impact on the detection of PC recurrent lesions that could be treated by local therapy to achieve long-term survival or cure."

-Patrick

ncbi.nlm.nih.gov/pubmed/293...

Nucl Med Commun. 2018 Jan 29. doi: 10.1097/MNM.0000000000000808. [Epub ahead of print]

Oligometastatic recurrent prostate cancer detects by fluorine-18-choline positron emission tomography/computed tomography in patients with prostate-specific antigen levels of up to 5 ng/ml.

Evangelista L1, Cuppari L1, Guttilla A2, Gardi M3, Agostini A3, Ruggera L4, Basso U5, Saladini G1.

Author information

1

Nuclear Medicine and Molecular Imaging Unit.

2

Department of Urology, Hospital of Camposampiero.

3

Department of Urology, Hospital of Sant'Antonio of Padova.

4

Department of Urology, Azienda Ospedaliera of Padova, Padova, Italy.

5

Oncology Unit 1, Veneto Institute of Oncology IOV, IRCCS.

Abstract

PURPOSE:

The aim of this study was to assess the ability of fluorine-18-fluorocholine (F-FCH) PET/computed tomography (CT) to detect oligometastatic disease (OMD) in patients with early recurrence of prostate cancer (PC) [prostate-specific antigen (PSA)≤5 ng/ml].

PATIENTS AND METHODS:

Between 2010 and 2016, 324 patients with PC and PSA levels of less than or equal to 5 ng/ml were recruited. The mean (SD) age of the patients was 71 (10) years. All patients were treated with a radical prostatectomy±lymphadenectomy. One-hundred and twenty-one patients were under hormonal therapy at the time of PET/CT, whereas 203 were not. The mean (SD) PSA at the time of PET/CT was 1.33 (1.19) ng/ml, the mean (SD) PSA doubling time (PSAdt) was 10 (12) months, and the mean (SD) PSA velocity (PSAvel) was 1.94 (3.31) ng/ml/year. The correlation between continuous and categorical data was assessed using Student's t-test or by analysis of variance and by the χ-test, respectively. Univariate and multivariate analysis was carried out for the identification of clinical variables able to predict the presence of OMD.

RESULTS:

One-hundred and ninety-three patients had a negative F-FCH PET/CT, whereas 131 (40.4%) had a positive scan. Of these latter patients, 35 had a significant F-FCH uptake in the prostatic fossae, 59 in the lymph nodes, and 37 in bone. PSA levels were significantly different between patients with a positive than those with a negative scan (P<0.001). F-FCH PET/CT was negative in the majority of patients with a PSA of less than or equal to 1 (63.2%) ng/ml. More than 60% of patients with a PSAdt of less than or equal to 6 months had a positive F-FCH PET/CT scan for OMD. PSAvel was higher in patients with a positive scan than those with a negative finding. At univariate analysis, PSA level, PSAdt, and PSAvel were predictors of a positive F-FCH PET/CT for OMD, whereas on multivariate analysis, only PSA level and PSAdt were independent predictors (both P<0.01). Furthermore, PSAdt was the only independent predictor of OMD at the lymph node level.

CONCLUSION:

In patients with early recurrence of PC, F-FCH PET/CT is able to detect OMD in 40% of cases. This finding has an important impact on the detection of PC recurrent lesions that could be treated by local therapy to achieve long-term survival or cure.

PMID: 29381584 DOI: 10.1097/MNM.0000000000000808

[snoraste]

Patrick - could you translate it a bit more for me please. Is this report saying that with 40% prob., PET/CT can detect newly formed metastasis? Which can then be locally treated?

[pjoshea13 in reply to snoraste]

In this particular population of men who failed RP & were imaged while PSA was <5, the choline PET scan was positive for only 40%.

The success rate was 60% when the PSA doubling time was <6 months.

As one might expect, the lower the PSA, the less chance of detection. But one could wait 6 months, say, & retest.

If a met shows up on the scan, it can be treated, except that:

a) one must find someone who treats oligometastatic PCa

b) & have mets that fall within his/her definition of "oligo", e.g. no more than 5.

No guarantee that dormant cells are not hanging out somewhere, but debulking is always good IMO.

-Patrick

[Dr_WHO]

Thank you. The thought that there is hope for a cure under these conditions is one of the major advances over the last year or two.

[GeorgeGlass]

I wonder why the psa had to be less than 5. Why does the PSA amount matter of you can barely see the cancer on the test? I thought high psa could just mean that a cancer location could emit more psa without it necessary meaning a wider spread of the cancer throughout the body.

[pjoshea13 in reply to GeorgeGlass]

George,

PSA<5 is arbitrary. Presumably, they wanted men with less serious cancer - or men at an earlier stage. The mean doubling time was 10 months, so they had a significant number of men with short PSADTs.

-Patrick

[GeorgeGlass]

Thanks Patrick. I'm still trying to figure out approximately what % of men with a very aggressive doubling time get long term, ~8 years or more, remission. I was thinking of posting a question on this site to see if anyone with a doubling time less than the months is still alive after 8 years, from nothing more than adt and other drugs such as zytiga or xtiga etc. Lupron alone is still working for me after the years but I'm wondering if if there is much hope for me after it stops working. My doubling time is faster than anyone I've met.

George

[pjoshea13 in reply to GeorgeGlass]

George,

I have had very short doubling times & am still here, (although I have not followed a conventional path.)

Early on, I identified NF-kB as something to be inhibited. It is chronically activated in PCa & is resposible for inflammatory agents associated with aggressive disease.

You can measure albumin & CRP to get some idea of your subclinical inflammation. But check out the 4 posts I had on the subject of inflammation a couple of years ago. You may be able to slow things down a bit.

-Patrick

[GeorgeGlass]

Ok Patrick. I'll look at those discussions. I remember my crp being around 0.35 i think. I'll look for the albumin.