<sup>11</sup>C-choline positron emission tomography/computed tomography for detection of disease relapse in patients with history of biochemically recurrent prostate cancer and prostate-specific antigen ≤0.1 ng/ml Garg I, Nathan MA, Packard AT, Kwon ED, Larson NB, Lowe V, Davis BJ, Haloi R, Mahon ML, Goenka AH,

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¹¹C-choline positron emission tomography/computed tomography for detection of disease relapse in patients with history of biochemically recurrent prostate cancer and prostate-specific antigen ≤0.1 ng/ml Ishan Garg¹, Mark A Nathan¹, Ann T Packard¹, Eugene D Kwon², Nicholas B Larson³, Val Lowe¹, Brian J Davis⁴, Rimki Haloi², Mindie L Mahon², Ajit H Goenka¹ ¹ Department of Radiology, Mayo Clinic, Rochester, MN, USA ² Department of Urology, Mayo Clinic, Rochester, MN, USA ³ Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA ⁴ Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA Correspondence Address: Ajit H Goenka, Department of Radiology, Mayo Clinic, 200 First St Sw, Charlton 1, Rochester, MN 55905 USA Source of Support: None, Conflict of Interest: None DOI: 10.4103/jcrt.JCRT_373_19 PMID: 33063697

Objectives: The objective was to evaluate the diagnostic performance of surveillance¹¹ C-choline positron emission tomography/computed tomography (PET/CT) for the detection of disease relapse in patients with a history of biochemically recurrent (BCR) prostate cancer (PCa) and prostate-specific antigen (PSA) ≤0.1 ng/ml. Materials and Methods: We included patients who had been treated for BCR PCa and had a surveillance¹¹ C-choline PET/CT at serum PSA ≤0.1 ng/ml. Positive surveillance PET/CT was defined as a study that identified a new tracer-avid lesion or new tracer uptake in a previously treated lesion or both. Findings were confirmed against a composite radiologic-pathologic gold standard. Time to recurrence association analyses were performed for disease relapse risk with the use of Cox proportional hazards regression. Results: In total, 13 (12.1%) of the 107 patients had positive surveillance PET/CT scans, confirmed on pathologic assessment (n = 5) and subsequent imaging (n = 8). Among these 13 patients, ten had distant metastases, two had local recurrence, and one had both. Nine of the ten patients with metastases had oligometastatic disease defined as the presence of ≤3 metastases. Serum PSA became detectable again in only seven patients with positive surveillance PET/CT, after a mean interval from surveillance PET/CT of 292 days (range: 105–543 days). We identified an association of N stage with increased risk of recurrence (hazard ratio = 3.85; P = 0.036) although this was not significant after accounting for multiple testing. Conclusions: Surveillance¹¹ C-choline PET/CT can detect early disease relapse at serum PSA ≤0.1 ng/ml in patients with a history of BCR PCa.

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