Percutaneous image-guided nodal biopsy after 11C-Choline PET/CT for biochemically recurrent prostate cancer: Imaging predictors of disease and clinical implications

SUMMARY Management of recurrent prostate cancer (CaP) necessitates timely diagnosis and accurate localization of recurrent disease. Our purpose was to assess predictors of histologic outcomes after C-11 choline positron emission tomography/computed tomography (CholPET). In this cohort where CNB was performed after CholPET, characteristics of choline localization including node location, SUVmax, lesion to blood pool SUV ratio, PSA, total Gleason score, and castrate resistance are significantly associated with positive biopsy for metastatic disease on CholPET. Percutaneous image guided nodal biopsy after C-11 Choline PET/CT for Biochemically Recurrent Prostate Cancer: Imaging Predictors of Disease and Clinical Implications. PURPOSE Management of recurrent prostate cancer (CaP) necessitates timely diagnosis and accurate localization of the site(s) of recurrent disease. The purpose of this study was to assess predictors of histologic outcomes after C-11 choline positron emission tomography/computed tomography (CholPET) to increase the positive predictive value and specificity of CholPET in identifying imaging predictors of malignant and benign nodal disease in order to better inform clinical decision-making regarding local therapy planning. MATERIALS AND METHODS Retrospective review of patients undergoing CholPET followed by percutaneous core needle biopsy (CNB) between 1/1/2010 and 1/1/2016. One hundred fifty three patients were identified who underwent 166 biopsy procedures. Patient, CholPET, procedural, and pathologic characteristics were recorded. RESULTS One hundred and fifty seven biopsies were technically successful and 110 (70.1%; 95% CI 62.2-77.1) yielded histology positive for metastatic CaP (mCaP). Lesion location, lesion SUVmax, SUV ratio (calculated as a ratio of SUVmax to SUV mean in the right atrium), prostate specific antigen (PSA), lesion short axis length, total Gleason score, and castration resistance were all associated with positive biopsies (p-values CONCLUSION In a cohort of patients where CNB was performed after CholPET, characteristics of choline localization including node location, SUVmax, lesion to blood pool SUV ratio, PSA, total Gleason score, and castrate resistance are significantly associated with positive biopsy for metastatic disease on CholPET. Relatively high false positive rates were observed in common iliac, external iliac, and inguinal lymph node locations. Histologic confirmation of these sites should be strongly considered in the appropriate clinical scenario before designing additional local therapy plans.