F-18-Fluorocholine PET/CT and MR Imaging/ Spectroscopy in the Management of Primary and Recurrent Prostate Cancer

• To evaluate the utility of F-18-FCH-PET/CT and MR imaging with 3-D MR spectroscopy in detecting, localizing, and estimating the volume of initial primary prostate cancer as compared to the current standard work-up using TRUS-guided biopsy. All imaging findings will be correlated with "gold standard" step slice histological examination. The hypothesis is that the combination of noninvasive imaging will improve the preoperative work-up as compared to the current approach.
• To evaluate FCH-PET for the restaging of prostate cancer after biochemical relapse in a large patient cohort. This will run in parallel to the work-up of primary prostate cancer, as the FCH radiopharmaceutical will be available during the time of study at absolutely no cost to patients or CHUV. A number of studies have demonstrated the benefits of F-18-FCH-PET/CT for these patients and this indication is currently not reimbursed by Swiss obligatory health insurance providers.

PRIMARY PROSTATE CANCER

Inclusion criteria

• Age ≤ 80 years
• Karnofsky index ≥ 80
• First prostate biopsy
• Presence of at least one of the following:

• Total PSA 10 ng/mL
• Total PSA 2.5-10 ng/mL with free-PSA <20% and/or PSA velocity 0.75 ng/mL/year
• Suspicious hypoechoic lesion at TRUS and/or suspicious finding at digital rec¬tal examination
• Informed signed consent.

Exclusion criteria

• Impaired capacity to consent
• Coexistence of clinically-proven prostate cancer
• Neoadjuvant hormonal treatment (including 5-α reductase inhibitors)
• Contraindications to surgery
• Contraindications to MR Imaging (see below)

PROSTATE CANCER RELAPSE

Inclusion criteria

• Age ≤ 90 years
• Karnofsky index ≥ 80
• Previous treatment for prostate cancer
• No clinical recurrence based on standard work-up (abdominal / pelvic CT, MRI, and bone scintigraphy)
• Biochemically proven relapse of prostate cancer (PSA > 0.2 ng/mL after prostatectomy, nadir PSA+2 ng/mL (Phoenix definition) or ≤ 3 successive rising PSA levels (ASTRO definition) after curative radiotherapy).
• Informed signed consent.

Exclusion criteria

• Coexistence of another clinically-proven cancer
• Contraindications to surgery or radiation therapy treatment