¹⁸F-fluorocholine PET/CT compared with extended pelvic lymph node dissection in high-risk prostate cancer

Area of Science:

• Oncology
• Nuclear Medicine
• Urology

Background:

• High-risk prostate cancer requires accurate staging for effective treatment planning.
• Detecting lymph node metastases is critical for determining prognosis and guiding therapy.
• Current imaging modalities have limitations in identifying small metastatic lymph nodes.

Purpose of the Study:

• To compare the diagnostic performance of (18)F-fluorocholine PET/CT with extended pelvic lymph node dissection (ePLND).
• To evaluate the ability of (18)F-fluorocholine PET/CT to detect lymph node metastases in patients with high-risk prostate cancer.

Main Methods:

• A cohort of 112 patients with high-risk prostate cancer underwent (18)F-fluorocholine PET/CT followed by ePLND.
• Patients had PSA levels 20-99 ng/mL or Gleason score 8-10 and negative/inconclusive bone scans.
• Histopathology from ePLND served as the reference standard for comparison.

Main Results:

• (18)F-fluorocholine PET/CT identified suspected metastases in 29% of patients, while ePLND found metastases in 43%.
• For lymph node metastases within the ePLND template, PET/CT sensitivity was 0.33 and specificity was 0.92.
• CT component of PET/CT alone identified enlarged lymph nodes (>10 mm) in only 11 patients.

Conclusions:

• (18)F-fluorocholine PET/CT demonstrates high specificity but limited sensitivity for detecting lymph node metastases in high-risk prostate cancer.
• The findings suggest that (18)F-fluorocholine PET/CT may miss a significant number of metastatic lymph nodes.
• ePLND remains essential for comprehensive staging in this patient population.