Skip to main content
SpringerLink
Log in

Prospective evaluation of [11C]Choline PET/CT in therapy response assessment of standardized docetaxel first-line chemotherapy in patients with advanced castration refractory prostate cancer

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to prospectively evaluate the value of [11C] Choline PET/CT in monitoring early and late response to a standardized first-line docetaxel chemotherapy in castration refractory prostate cancer (mCRPC) patients.

Methods

Thirty-two patients were referred for [11C] Choline PET/CT before the start of docetaxel chemotherapy, after one and ten chemotherapy cycles (or - in case of discontinuation - after the last administered cycle) for therapy response assessment. [11C] Choline uptake (SUVmax, SUVmean), CT derived Houndsfield units (HUmax, HUmean), and volume of bone, lung, and nodal metastases and local recurrence were measured semi-automatically at these timepoints. Change in SUVmax, SUVmean, HUmax, HUmean, and volume was assessed between PET 2 and 1 (early response assessment, ERA) and PET 3 and 1 (late response assessment, LRA) on a patient and lesion basis. Results of PET/CT were compared to clinically used RECIST 1.1 and clinical criteria based therapy response assessment including PSA for defining progressive disease (PD) and non-progressive disease (nPD), respectively. Relationships between changes of SUVmax and SUVmean (early and late) and changes of PSAearly and PSAlate were evaluated. Prognostic value of initial SUVmax and SUVmean was assessed. Statistical analyses were performed using SPSS.

Results

In the patient-based ERA and LRA there were no statistically significant differences in change of choline uptake, HU, and volume between PD and nPD applying RECIST or clinical response criteria. In the lesion-based ERA, decrease in choline uptake of bone metastases was even higher in PD (applying RECIST criteria), whereas in LRA the decrease was higher in nPD (applying clinical criteria). There were only significant correlations between change in choline uptake and PSA in ERA in PD, in LRA no significant correlations were discovered. Initial SUVmax and SUVmean were statistically significantly higher in nPD (applying clinical criteria).

Conclusion

There is no significant correlation between change in choline uptake in [11C] Choline PET/CT and clinically routinely used objective response assessment during the early and late course of docetaxel chemotherapy. Therefore, [11C] Choline PET/CT seems to be of limited use in therapy response assessment in standardized first-line chemotherapy in mCRPC patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Siegel RL, Sahar L, Portier KM, Ward EM, Jemal A. Cancer death rates in US congressional districts. CA Cancer J Clin. 2015;65:339–44.

    Article  PubMed  Google Scholar 

  2. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65:467–79.

    Article  CAS  PubMed  Google Scholar 

  3. Berthold DR, Pond GR, Roessner M, de Wit R, Eisenberger M, Tannock AI. Treatment of hormone-refractory prostate cancer with docetaxel or mitoxantrone: relationships between prostate-specific antigen, pain, and quality of life response and survival in the TAX-327 study. Clin Cancer Res. 2008;14:2763–7.

    Article  CAS  PubMed  Google Scholar 

  4. Nakano K, Komatsu K, Kubo T, Natsui S, Nukui A, Kurokawa S, et al. External validation of risk classification in patients with docetaxel-treated castration-resistant prostate cancer. BMC Urol. 2014;14:31.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Thalgott M, Rack B, Eiber M, Souvatzoglou M, Heck MM, Kronester C, et al. Categorical versus continuous circulating tumor cell enumeration as early surrogate marker for therapy response and prognosis during docetaxel therapy in metastatic prostate cancer patients. BMC Cancer. 2015;15:458.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  CAS  PubMed  Google Scholar 

  7. Messiou C, Cook G, De Souza NM. Imaging metastatic bone disease from carcinoma of the prostate. Br J Cancer. 2009;101:1225–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bubley GJ, Carducci M, Dahut W, Dawson N, Daliani D, Eisenberger M, et al. Eligibility and response guidelines for phase II clinical trials in androgen-independent prostate cancer: recommendations from the prostate-specific antigen working group. J Clin Oncol. 1999;17:3461–7.

    CAS  PubMed  Google Scholar 

  9. Ceci F, Castellucci P, Graziani T, Schiavina R, Renzi R, Borghesi M, et al. (11) C-Choline PET/CT in castration-resistant prostate cancer patients treated with docetaxel. Eur J Nucl Med Mol Imaging. 2016;43:84–91.

    Article  CAS  PubMed  Google Scholar 

  10. Mulders PF, Schalken JA. Measuring therapeutic efficacy in the changing paradigm of castrate-resistant prostate cancer. Prostate Cancer Prostatic Dis. 2009;12:241–6.

    Article  CAS  PubMed  Google Scholar 

  11. Basu S, Kumar R, Ranade R. Assessment of treatment response using PET. PET Clin. 2015;10:9–26.

    Article  PubMed  Google Scholar 

  12. Maffione AM, Marzola MC, Capirci C, Colletti PM, Rubello D. Value of (18) F-FDG PET for predicting response to Neoadjuvant therapy in rectal cancer: systematic review and meta-analysis. AJR Am J Roentgenol. 2015;204:1261–8.

    Article  PubMed  Google Scholar 

  13. Courtney KD, Manola JB, Elfiky AA, Ross R, Oh WK, Yap JT, et al. A phase I study of everolimus and docetaxel in patients with castration-resistant prostate cancer. Clin Genitourin Cancer. 2015;13:113–23.

    Article  PubMed  Google Scholar 

  14. De Giorgi U, Caroli P, Burgio SL, Menna C, Conteduca V, Bianchi E, et al. Early outcome prediction on 18F-fluorocholine PET/CT in metastatic castration-resistant prostate cancer patients treated with abiraterone. Oncotarget. 2014;5:12448–58.

    Article  PubMed  PubMed Central  Google Scholar 

  15. De Giorgi U, Caroli P, Scarpi E, Conteduca V, Burgio SL, Menna C, et al. (18) F-Fluorocholine PET/CT for early response assessment in patients with metastatic castration-resistant prostate cancer treated with enzalutamide. Eur J Nucl Med Mol Imaging. 2015;42:1276–83.

    Article  PubMed  Google Scholar 

  16. Pascali C, Bogni A, Iwata R, Cambie M, Bombardieri E. [11C] methylation on a C18 Sep-Pak cartridge: a convenient way to produce [M-methyl-11C]choline. J Label Compd Radiopharm. 2000;43:195–203.

    Article  CAS  Google Scholar 

  17. Khoury JD, Adcock DM, Chan F, Symanowski JT, Tiefenbacher S, Goodman O, et al. Increases in quantitative D-dimer levels correlate with progressive disease better than circulating tumor cell counts in patients with refractory prostate cancer. Am J Clin Pathol. 2010;134:964–9.

    Article  CAS  PubMed  Google Scholar 

  18. Thalgott M, Heck MM, Eiber M, Souvatzoglou M, Hatzichristodoulou G, Kehl V, et al. Circulating tumor cells versus objective response assessment predicting survival in metastatic castration-resistant prostate cancer patients treated with docetaxel chemotherapy. J Cancer Res Clin Oncol. 2015;141:1457–64.

    Article  CAS  PubMed  Google Scholar 

  19. Young H, Baum R, Cremerius U, Herholz K, Hoekstra O, Lammertsma AA, et al. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European organization for research and treatment of cancer (EORTC) PET study group. Eur J Cancer. 1999;35:1773–82.

    Article  CAS  PubMed  Google Scholar 

  20. Evangelista L, Bombardieri E. Prostate-specific antigen and radiolabelled choline PET/CT for the assessment of response to therapy: synergy or conflicting? Eur J Nucl Med Mol Imaging. 2015

  21. Caffo O, Maines F, Donner D, Veccia A, Chierichetti F, Galligioni E. Impact of enzalutamide administration on primary prostate cancer volume: a metabolic evaluation by choline positron emission tomography in castration-resistant prostate cancer patients. Clin Genitourin Cancer. 2014;12:312–6.

    Article  PubMed  Google Scholar 

  22. Pezaro CJ, Omlin A, Lorente D, Nava Rodrigues D, Ferraldeschi R, Bianchini D, et al. Visceral disease in castration-resistant prostate cancer. Eur Urol. 2014;65:270–3.

    Article  PubMed  Google Scholar 

  23. Oyama N, Akino H, Suzuki Y, Kanamaru H, Sadato N, Yonekura Y, et al. The increased accumulation of [18F] fluorodeoxyglucose in untreated prostate cancer. Jpn J Clin Oncol. 1999;29:623–9.

    Article  CAS  PubMed  Google Scholar 

  24. Scher HI, Halabi S, Tannock I, Morris M, Sternberg CN, Carducci MA, et al. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the prostate cancer clinical trials working group. J Clin Oncol. 2008;26:1148–59.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank Michael Souvatzoglou as well as the PET team, especially Brigitte Dzewas, Coletta Kruschke, and Nicola Henke.

Author information

Author notes

    Authors and Affiliations

    1. Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

      Sarah M. Schwarzenböck, Matthias Eiber, Markus Schwaiger & Bernd J. Krause

    2. Department of Nuclear Medicine, Rostock University Medical Centre, Gertrudenplatz 1, 18057, Rostock, Germany

      Sarah M. Schwarzenböck, Monique Sakretz, Jens Kurth & Bernd J. Krause

    3. Department of Biostatistics and Informatics, Rostock University Medical Centre, Ernst-Heydemann-Str. 8, 18057, Rostock, Germany

      Günther Kundt

    4. Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

      Margitta Retz, Uwe Treiber, Roman Nawroth, Jürgen E. Gschwend & Mark Thalgott

    5. Institute of Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

      Ernst. J. Rummeny

    Authors
    1. Sarah M. Schwarzenböck
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Matthias Eiber
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Günther Kundt
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Margitta Retz
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Monique Sakretz
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Jens Kurth
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Uwe Treiber
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Roman Nawroth
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Ernst. J. Rummeny
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Jürgen E. Gschwend
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Markus Schwaiger
      View author publications

      You can also search for this author in PubMed Google Scholar

    12. Mark Thalgott
      View author publications

      You can also search for this author in PubMed Google Scholar

    13. Bernd J. Krause
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Sarah M. Schwarzenböck.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Mark Thalgott and Bernd J. Krause shared senior authorship

    Mark Thalgott and Bernd J. Krause contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Schwarzenböck, S.M., Eiber, M., Kundt, G. et al. Prospective evaluation of [11C]Choline PET/CT in therapy response assessment of standardized docetaxel first-line chemotherapy in patients with advanced castration refractory prostate cancer. Eur J Nucl Med Mol Imaging 43, 2105–2113 (2016). https://doi.org/10.1007/s00259-016-3439-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00259-016-3439-9

    Keywords

    Search

    Navigation