© 2010 THE AUTHORS JOURNAL COMPILATION © 2 0 1 0 B J U I N T E R N A T I O N A L | 1 0 6 , 6 3 9 – 6 4 4 | doi:10.1111/j.1464-410X.2009.09191.x 639 2009 THE AUTHORS. JOURNAL COMPILATION 2009 BJU INTERNATIONAL Original Articles PET/CT FOR LYMPH NODE STAGING OF PATIENTS WITH PROSTATE CANCER POULSEN ET AL. [ 18 F]-fluorocholine positron-emission/computed tomography for lymph node staging of patients with prostate cancer: preliminary results of a prospective study Mads H. Poulsen, Kirsten Bouchelouche*, Oke Gerke* † , Henrik Petersen*, Birgitte Svolgaard ‡ , Niels Marcussen § , Niels Svolgaard, Mattias Ögren*, Werner Vach † , Poul F. Høilund-Carlsen*, Ulla Geertsen and Steen Walter Departments of Urology, *Nuclear Medicine, ‡ Radiology, and § Pathology, Odense University Hospital, and † Department of Statistics, University of Southern Denmark, Odense, Denmark Accepted for publication 6 November 2009 scanned before lymphadenectomy. Each patient was assessed twice with imaging, at 15 and 60 min after the injection with FCH. Images were compared with the results of histopathological examination of the surgically removed lymph nodes. Maximum standardized uptake values (SUV max ) at 15 and 60 min were also compared. RESULTS Histopathologically, metastases were present in removed lymph nodes from three patients. FCH PET/CT showed a high radiotracer uptake in four patients, the former three and a fourth. The sensitivity, specificity, positive and negative predictive value of FCH PET/CT for patient based lymph node staging of prostate cancer were 100%, 95%, 75% and 100%, respectively; the corresponding 95% confidence intervals were 29.2–100%, 77.2–99.9%, 19.4–99.4% and 83.9–100%, respectively. Values of SUV max at early and late imaging were not significantly different. CONCLUSIONS This small series supports the use of FCH PET/ CT as a tool for lymph node staging of patients with prostate cancer. Values of SUV max at early and late imaging did not differ. However, larger prospective studies are needed to validate these findings. KEYWORDS prostate cancer, lymph node staging, [ 18 F]-fluorocholine, PET/CT Study Type – Diagnostic (case series) Level of Evidence 4 OBJECTIVES To evaluate prospectively [ 18 F]-fluorocholine positron-emission/computed tomography (FCH PET/CT) for lymph node staging of prostate cancer before intended curative therapy, and to determine whether imaging 15 or 60 min after radiotracer injection is preferable. PATIENTS AND METHODS In all, 25 consecutive patients with newly diagnosed prostate cancer (Gleason score >6, and/or a prostate-specific antigen level of >10 ng/mL, and/or T3 cancer) were INTRODUCTION Primarily, prostate cancer is staged on the basis of a clinical examination, the patient’s Gleason score, PSA level and T stage according to the TNM classification. In patients with a high risk of disseminated disease, the N and M stages are further evaluated. Traditionally, the lymph nodes are examined by lymphadenectomy. Currently, 30–50% of patients who receive intended curative therapy have a recurrence [1,2], one of the reasons being undetected lymph node involvement [3]. As lymphadenectomy and subsequent intended curative therapy are associated with morbidity and mortality [3,4], methods to more precisely reveal lymph node involvement are being sought. Trials on lymph node staging of patients with traditional CT or MRI have been disappointing in showing a low sensitivity with both methods [5–7]. Studies of positron-emission tomography (PET)/CT show that this method, with newer radiotracer molecules like choline, might have a potential role in both N and M staging of prostate cancer, and would be preferable because it is a noninvasive whole-body examination [8,9]. The most commonly used PET radiotracer, [ 18 F]-fluorodeoxyglucose, is not ideal in prostate cancer due to the generally low metabolism of prostate adenocarcinomas [10]. However, [ 18 F]- fluorocholine (FCH) is a radiotracer that has shown promising results for staging prostate cancer [11–13]. The optimal distribution time for the FCH radiotracer is still to be established. If FCH PET/CT can detect lymph node metastases better than conventional imaging methods, staging might improve and more patients would avoid the surgical trauma of lymphadenectomy, while achieving a more accurate staging of their disease and a more optimal treatment. We present pilot data from a recently started prospective trial on the value of FCH PET/CT for lymph node staging of prostate cancer, using histopathological examination of BJUI BJU INTERNATIONAL