FDG-PET-CT for pre-operative staging and prognostic stratification of patients with high-grade prostate cancer at biopsyReport as inadecuate




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Cancer Imaging

, 15:2

First Online: 03 March 2015Received: 30 July 2014Accepted: 20 February 2015DOI: 10.1186-s40644-015-0038-0

Cite this article as: Beauregard, JM., Blouin, AC., Fradet, V. et al. cancer imaging 2015 15: 2. doi:10.1186-s40644-015-0038-0

Abstract

BackgroundThe role of F-fluorodeoxyglucose positron emission tomography-computed tomography FDG-PET-CT in prostate cancer PCa has not been well defined yet. Because high-grade PCa tends to exhibit increased glycolytic rate, FDG-PET-CT could be useful in this setting. The aim of this study was to assess the value of FDG-PET-CT for pre-operative staging and prognostic stratification of patients with high-grade PCa at biopsy.

MethodsFifty-four patients with a Gleason sum ≥8 PCa at biopsy underwent FDG-PET-CT as part of the staging workup. Thirty-nine patients underwent radical prostatectomy RP and pelvic lymph node LN dissection, 2 underwent LN dissection only, and 13 underwent non-surgical treatments. FDG-PET-CT findings from clinical reports, blinded reading and quantitative analysis were correlated with clinico-pathological characteristics at RP.

ResultsSuspicious foci of increased FDG uptake were found in the prostate, LNs and bones in 44, 13 and 6% of patients, respectively. Higher clinical stage, post-RP Gleason sum and pattern, and percentage of cancer involvement within the prostate were significantly associated with the presence of intraprostatic FDG uptake IPFU P < 0.05 in all cases. Patients without IPFU who underwent RP were downgraded to Gleason ≤7 in 84.6% of cases, as compared to 30.8% when IPFU was reported P = 0.003. Qualitative and quantitative IPFU were significantly positively correlated with post-RP Gleason pattern and sum, and pathological T stage. Absence and presence of IPFU were associated with a median 5-year cancer-free survival probability of 70.2 and 26.9% P = 0.0097, respectively, using the CAPRA-S prognostic tool.

ConclusionThese results suggest that, among patients with a high-grade PCa at biopsy, FDG-PET-CT could improve pre-treatment prognostic stratification by predicting primary PCa pathological grade and survival probability following RP.

KeywordsFDG-PET-CT High-grade Prognostic stratification Prostate cancer Staging Jean-Mathieu Beauregard and Annie-Claude Blouin contributed equally to this work.

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Author: Jean-Mathieu Beauregard - Annie-Claude Blouin - Vincent Fradet - André Caron - Yves Fradet - Claude Lemay - Louis Lacombe

Source: https://link.springer.com/







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