Background: To evaluate and compare the utility of 18F-fluorocholine (18F-CH) PET/CT versus 3-Tesla multiparametric\nMRI (mpMRI) without endorectal coil to detect tumor recurrences in patients with biochemical relapse following\nradical prostatectomy (RP). Secondarily, to identify possible prognostic variables associated with mpMRI and 18F-CH\nPET/CT findings.\nMethods: Retrospective study of 38 patients who developed biochemical recurrence after RP between the years 2011\nand 2015 at our institution. PET/CT and mpMRI were both performed within 30 days of each other in all patients. The\nPET/CT was reviewed by a nuclear medicine specialist while the mpMRI was assessed by a radiologist, both of whom\nwere blinded to outcomes.\nResults: The median prostate-specific antigen (PSA) value pre-MRI/PET-CT was 0.9 ng/mL (interquartile range 0.4ââ?¬â??2.\n2 ng/mL). There were no differences in the detection rate between 18F-CH PET/CT and mpMRI for local recurrence\n(LR), lymph node recurrence (LNR) and bone metastases (BM). Separately, mpMRI and 18F-CH PET/CT were positive for\nrecurrence in 55.2% and 52.6% of cases, respectively, and in 65.7% of cases when findings from both modalities were\nconsidered together. The detection of LR was better with combined mpMRI and choline PET/CT versus choline PET/CT\nalone (34.2% vs 18.4%, p = 0.04). Salvage treatment was modified in 22 patients (57.8%) based on the imaging findings.\nPSA values on the day of biochemical failure were significantly associated with mpMRI positivity (adjusted odds ratio\n(OR): 30.9; 95% confidence interval (CI): 1.5ââ?¬â??635.8). Gleason score > 7 was significantly associated with PET/CT positivity\n(OR: 13.9; 95% CI: 1.5ââ?¬â??125.6). A significant association was found between PSA doubling time (PSADT) (OR: 1.3; 95%\nCI: 1.0ââ?¬â??1.7), T stage (OR: 21.1; 95% CI: 1.6ââ?¬â??272.1), and LR.\nConclusions: Multiparametric MRI and 18F-CH PET/CT yield similar detection rates for LR, LNR and pelvic BM. The\ncombination of both imaging techniques provides a better LR detection versus choline PET/CT alone. The initially\nplanned salvage treatment was modified in 57.8% of patients due to imaging findings. In addition to PSA values,\nGleason score, T stage, and PSADT may provide valuable data to identify those patients that are most likely to benefit\nfrom undergoing both imaging procedures.
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