Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press49210.17650/1726-9776-2015-11-3-79-86PROSTATE CANCERРАК ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ11C–Choline PET / CT in the detection of prostate cancer relapse in patients with rising PSAПЭТ / КТ с 11С-холином в диагностике рецидива рака предстательной железы у пациентов с биохимическим прогрессированиемAslanidisI. P.АсланидиИ. П.
Russian Federation
PursanovaD. M.ПурсановаД. М.
Russian Federation
dipoursanidou@gmail.comMukhortovaO. V.МухортоваО. В.
Russian Federation
SilchenkovA. V.СильченковА. В.
Russian Federation
RoshinD. A.РощинД. А.
Russian Federation
KoryakinA. V.КорякинА. В.
Russian Federation
IvanovS. A.ИвановС. А.
Russian Federation
ShirokoradV. I.ШирокорадВ. И.
Russian Federation
ФГБУ «Научный центр сердечно-сосудистой хирургии им. А. Н. Бакулева» Минздрава РоссииРоссия, 121552, Москва, Рублевское шоссе, 135ФГБУ «Научный центр сердечно-сосудистой хирургии им. А. Н. Бакулева» Минздрава РоссииBakoulev Scientific Center for Cardiovascular Surgery of the Ministry of Health of the Russian FederationРоссия, 121552, Москва, Рублевское шоссе, 135135 Rublevskoye shosse, Moscow, 121552, RussiaФГБУ «Научный центр сердечно-сосудистой хирургии им. А. Н. Бакулева» Минздрава РоссииN. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian FederationРоссия, 121552, Москва, Рублевское шоссе, 1354 Bldg, 51, 3end Parkovaya str., Moscow, 105425, RussiaНИИ урологии и интервенционной радиологии им. Н. А. Лопаткина – филиал ФГБУ «Национальный медицинский исследовательский радиологический центр» Минздрава РоссииN. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian FederationРоссия, 105425, Москва, ул. Парковая 3-я, 51, стр. 44 Bldg, 51, 3end Parkovaya str., Moscow, 105425, RussiaНИИ урологии и интервенционной радиологии им. Н. А. Лопаткина – филиал ФГБУ «Национальный медицинский исследовательский радиологический центр» Минздрава РоссииA. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian FederationРоссия, 105425, Москва, ул. Парковая 3-я, 51, стр. 410 Zhukov st., Obninsk, 249036, Kaluga region, RussiaМедицинский радиологический научный центр им. А. Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский радиологический центр» Минздрава РоссииMoscow City Cancer Hospital Sixti-TwoРоссия, 249036, Калужская область, Обнинск, ул. Жукова, 10Istra Township 27, Krasnorgorsky District, Moscow Region, 143500, RussiaМосковская городская онкологическая Больница № 62 ДЗ г. МосквыРоссия, 143500, Московская область, Красногорский район, пос. Истра, 273009201511379862409201524092015https://oncourology.abvpress.ru/oncur/article/view/492

Objective. To evaluate the diagnostic impact of 11C–Choline PET / CT in the detection of recurrent prostate cancer (PCa) in patients with biochemical relapse after radical prostatectomy and to assess the correlation between PSA levels and PET / CT detection rate of PCa relapse.

Subjects and methods. 85 patients with biochemical relapse (mean PSA 3.51 ± 3.87 ng / ml) after radical prostatectomy (n = 64) and radiotherapy (n = 21) underwent 11C–Choline PET / CT. According to PSA level, patients were divided into three groups:  2 ng / ml, 2 to 9 ng / ml and > 9 ng / ml.

Results. Overall, 11C–Choline PET / CT detected PCa relapse in 33 of 85 patients (39 %). The mean PSA value in PET-positive patients was 5.78 ± 4.95 (0.22–17.80) ng / ml, while in PET-negative patients – 1.43 ± 1.08 (0.28–4.57) ng / ml. Positive PET / CT results were obtained in 9 of 40 patients (22 %) with PSA of < 2 ng / ml, in 17 of 38 patients (45 %) with PSA of 2 to 9 ng / ml, and in 7 of 7 patients (100 %) with PSA of > 9 ng / ml. Local relapse was detected in 42 % (14 / 33) patients. Both local and distant metastases were diagnosed in 39 % (13 / 33) cases. Distant relapsewas identified in 19 % (6 / 33) cases. PET / CT allowed to assess the efficacy of treatment in 26 % (12 / 47) PET-negative patients under hormone therapy at the scan time. However, PET / CT wasn’t able to localize the site of PCa recurrence in these hormone-ensitive patients what might have affected the overall detection rate.

Conclusion. 1) 11C–Choline PET / CT was able to detect and correctly identify the site of PCa relapse in 39 % cases and therefore was useful in determining the further therapeutic approach. 2) Our data confirmed the strong correlation between PSA levels and 11C–Choline PET / CT detection rate of PCa relapse (r = 0.9; p < 0.001). 3) 11C–Choline PET / CT has limited utility in localizing the site of PCa recurrence in some patients under hormone therapy.

Цель исследования – изучить возможности позитронно-эмиссионной томографии (ПЭТ), совмещенной с компьютерной томографией (ПЭТ / КТ) с 11С-холином в ранней диагностике прогрессирования рака предстательной железы (РПЖ) у больных после радикального лечения. Определить наличие корреляции между уровнем простатспецифического антигена (ПСА) и частотой выявления рецидива РПЖ при ПЭТ / КТ с 11С-холином.

Материалы и методы. Проанализированы результаты 85 ПЭТ / КТ- исследований с 11С-холином у больных с биохимическим рецидивом РПЖ после различных видов лечения: радикальной простатэктомии (n = 64) и лучевой терапии (n = 21). В зависимости от уровня ПСА пациенты были разделены на 3 группы: < 2,0 нг / мл, 2,0–9,0 нг / мл и > 9,0 нг / мл. Среднее значение ПСА на момент исследования составляло 3,51 ± 3,87 (0,22–17,80) нг / мл.

Результаты. По результатам ПЭТ / КТ рецидив РПЖ был диагностирован в 39 % (33 / 85) случаев. Средний уровень ПСА у ПЭТ-положительных больных составил 5,78 ± 4,95 (0,22–17,80) нг / мл и был значимо выше, чем у ПЭТ-отрицательных: 1,43 ± 1,08 (0,28–4,57) нг / мл. Выявлена прямая корреляция между частотой диагностики рецидива РПЖ по данным ПЭТ / КТ и уровнем ПСА: у больных с уровнем ПСА < 2 нг / мл ПЭТ-положительные результаты получены в 22 % (9 / 40), при ПСА 2–9 нг / мл – в 45 % (17 / 38) и при ПСА >9 нг / мл – в 100 % (7 / 7) случаев. Локальный и сочетанный рецидивы диагностированы с одинаковой частотой. Местный рецидив выявлен в 42 % (14 / 33) случаях, локальный рецидив в сочетании с отдаленными метастазами – в 39 % (13 / 33), только отдаленные метастазы – в 19 % (6 / 33) случаев. В группе ПЭТ-отрицательных больных 26 % (12 / 47) исследований проводили на фоне гормонотерапии (ГТ) в короткие сроки (в течение 7 дней) после введения лекарственных препаратов, которые в дальнейшем были расценены как ложноотрицательные. Получение ПЭТ-отрицательных результатов у данных больных, вероятнее всего, свидетельствовало о снижении метаболической активности процесса на фоне проводимой ГТ, что не позволяло определить локализацию рецидивного процесса.

Выводы. 1) Результаты ПЭТ / КТ подтвердили рецидив заболевания, позволили определить его локализацию и распространенность у 39 % пациентов, что имело принципиальное значение для последующего лечения. 2) Выявлена прямая сильная корреляция между частотой выявления рецидива РПЖ при ПЭТ / КТ с 11С-холином и уровнем ПСА (r = 0,9; р < 0,001). 3) Выполнение ПЭТ / КТ в короткие сроки после введения гормональных препаратов не позволяет определить локализацию рецидива РПЖ.

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