Appearing in the European Journal of Nuclear Medicine and Molecular Imaging a recent study provides data on the long-term survival of men with a biochemical recurrence after failed surgery.

In the study by Giovacchini et al. it was shown that a PET/CT scan (specifically a [11C] choline PET/CT) could predict the long-term survival of men who are hormone-naive (not yet started ADT) who had a biochemical failure (where biochemical failure was defined by a PSA level > 0.2 ng/ml post surgery).

The study was a retrospective analysis of  302 men who were hormone-naive and who had been previously treated with a radical prostatectomy. The study was performed between December 1, 2004 and July 31, 2007.

The median PSA level of the 302 patients was 1.02 ng/ml.

In those men who had a positive PET/CT scan their median prostate cancer-specific survival after surgery was 14.9 years. The probability of prostate cancer-specific survival after 15 years post surgery was 42.4 percent.

Men having a negative PET/CT scan had a probability of prostate cancer-specific survival at 15 years of 95.5 percent.

Despite this finding the study authors did note that additional, prospective studies are needed to confirm these data before more extensive use of [11C]choline PET/CT scan data in the prognostic stratification of prostate cancer patients.

However, it does look like (subject to additional confirmation) that in a man with a biochemical recurrence who was still hormone naïve having a [11C]choline PET/CT scan can use the scan to predict their long-term survival. Men with a positive scan need to move on to treatment while men with a negative scan can consider, in consultation with their doctor, the equivalent to active surveillance.

We should also note that the median prostate cancer-specific survival of the PET/CT scan-negative men in this study had not been reached during the follow-up 15-year period regardless of their Gleason score. It is clear that for the men with a negative PET/CT their prostate cancer-survival is a great deal longer than the 15 years.

Before making any decision about moving a head with treatment or delaying treatment you must have an extensive conversation with your oncologist. You must be sure that you understand the risks of delaying treatment as well as the risks of moving a head with treatment.

[11C]Choline PET/CT predicts survival in hormone-naive prostate cancer patients with biochemical failure after radical prostatectomy; Giampiero Giovacchini; Elena Incerti; Paola Mapelli; Margarita Kirienko; Alberto Briganti; Giorgio Gandaglia; Francesco Montorsi; Luigi Gianolli; Maria Picchio
Pages: 877 – 884

Joel T. Nowak, M.A., M.S.W.