C-11 Choline PET-CT Scan in Finding Metastases in Patients With Newly Diagnosed High-Risk Prostate Cancer

OBJECTIVES:

Primary

• To determine the sensitivity and specificity of PET-CT scan using C-11 choline in detecting bone and lymph node metastases in patients with newly diagnosed high-risk adenocarcinoma of the prostate.

Secondary

• To perform semi-quantitative analysis of tracer uptake using standard uptake values and qualitative analysis using pure visual analysis.
• To develop an algorithm that includes the routine use of C-11 choline PET-CT scan for the staging of patients with prostate cancer at high risk of metastatic disease.
• To determine whether the presence of C-11 choline PET-CT scan positivity in these patients is predictive of outcomes, including biochemical relapse-free survival, time to development of clinically apparent metastases, time to local failure, and overall survival.
• To obtain tissue specimens from these patients for correlative studies and further evaluation.
• To obtain information regarding the feasibility and characteristics of C-11 choline PET-CT scan after androgen suppression.

OUTLINE: Patients undergo CT scan of the abdomen and pelvis with IV contrast and a bone scan. Patients also undergo a C-11 choline PET-CT scan*. In the case of any positive scan, patients undergo a needle biopsy. If the biopsy is negative for metastatic disease or if the biopsy is positive for metastatic disease in a draining lymph node region, patients receive radiotherapy and hormonal (antiandrogen) therapy. If the biopsy is positive for metastatic disease at any other site, patients receive hormonal therapy alone.

NOTE: *The first 10 patients enrolled on the study who have a positive PET-CT scan and positive biopsy undergo a second PET-CT scan at 6 months after the initial PET-CT scan.

Patients are followed every 3 months for 1 year and then every 6 months for 1 year.

Inclusion criteria

• Histologically confirmed adenocarcinoma of the prostate
• Prior negative prostate biopsy allowed
• High-risk disease, as defined by one of the following:
• PSA ≥ 20 ng/mL
• Gleason score ≥ 8
• Digital rectal examination revealing ≥ T2c disease (tumor involving more than one half of one lobe of the prostate)
• Creatinine < 2.0 mg/dL
• Able to tolerate PET scan, CT scan, and bone scan
• Able to tolerate IV and oral contrast
• Willing to undergo biopsy of positive findings on PET-CT scan, CT scan, or bone scan

Exclusion criteria

• Other cancer within the past 5 years (except for nonmelanoma skin cancer)
• No prior radiotherapy, hormonal therapy, surgery (other than biopsy), or cryotherapy for prostate cancer Prior transurethral resection of the prostate allowed