First Results of [11C]choline PET/CT-Guided Secondary Lymph Node Surgery in Patients with PSA Failure and Single Lymph Node Recurrence after Radical Retropubic Prostatectomy

INTRODUCTION: [(11)C]choline PET/CT provides the opportunity to detect small lymph node metastases (LNM) (>5 mm) in prostate cancer (PCa) with exact topographic allocation. PSA development after resection of single LN recurrence detected via [(11)C]choline PET/CT without adjuvant therapy is not yet analyzed. We wanted to evaluate the potential of [(11)C]choline PET/CT in the diagnosis of single LN recurrence after radical prostatectomy (RPE) and whether secondary resection can result in PSA remission. METHODS: We investigated 6 patients with biochemical recurrence (PSA: median 2.04, range 0.67-4.51 ng/ml) after RPE. A single suspicious LN was detected on PET/CT without suspicion of local relapse or distant metastasis. The suspicious and nearby LN were open dissected (09/2004-02/2008). Histological and PET/CT findings were compared and the postoperative PSA development was examined. RESULTS: All metastasis-suspicious LN could be confirmed histologically. The additionally removed 10 LN were all correctly negative for cancer. Three patients showed a complete permanent PSA remission (<0.01 (n = 2), <0.03 ng/ml (n = 1)) without adjuvant therapy (follow-up: median 24, range 21-35 months). CONCLUSIONS: In this small selected collective [(11)C]choline PET/CT achieved reliable results. After resection of single LNM in all patients the oncologic criteria of a remission were fulfilled. Three of 6 patients had a complete PSA remission without adjuvant therapy. Whether cure or a positive influence on the course of disease can be achieved in individual patients has to be shown in further studies.