@article{discovery10066851,
          number = {6},
           month = {June},
         journal = {Journal of Nuclear Medicine},
            year = {2019},
           title = {Prospective, Multisite, International Comparison of 18F-Fluoromethylcholine PET/CT, Multiparametric MRI, and 68Ga-HBED-CC PSMA-11 PET/CT in Men with High-Risk Features and Biochemical Failure After Radical Prostatectomy: Clinical Performance and Patient Outcomes},
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
          volume = {60},
           pages = {794--800},
        keywords = {Fluoromethyl-choline, MRI, Molecular Imaging, Oncology: GU, PET, PSMA, Prostate cancer, biochemical recurrence},
        abstract = {BACKGROUND: A significant proportion of men with rising PSA following radical prostatectomy (RP) fail prostate fossa salvage radiotherapy (SRT). This study assessed the ability of F18 fluoro-methyl-choline PET/CT(FCH), Ga-68 HBED-CC PSMA-11 PET/CT (PSMA) and pelvic multi-parametric magnetic resonance imaging (pelvic MRI) to identify men who will best benefit from SRT.

METHODS: Prospective, multisite, imaging study in men with rising PSA post RP, high-risk features (PSA {\ensuremath{>}} 0.2ng/mL and either Gleason Score (GS) {\ensuremath{>}} 7 or PSA doubling time {\ensuremath{<}}10 months, or PSA {\ensuremath{>}}1.0ng/mL) and negative /equivocal conventional imaging (CT and bone scan) being considered for SRT. FCH (91/91), Pelvic MRI (88/91) and PSMA (31/91) (Australia only) were performed within two weeks. Imaging was interpreted by experienced local and central reads blinded to other imaging results with consensus for discordance. Imaging results were validated using a composite reference standard. Expected management was documented pre and post- imaging, and all treatments, biopsies and PSA collected for 3 years. Treatment response to SRT was defined as {\ensuremath{>}} 50\% PSA reduction without androgen deprivation therapy.

RESULTS: Median GS, PSA at imaging and PSA doubling time were 8, 0.42(IQR 0.29-0.93) ng/mL, and 5.0 (IQR 3.3-7.6) months, respectively. Overall recurrent PCa was detected in 28\% (25/88) with pelvic MRI, 32\% (29/91) FCH and 42\% (13/31) PSMA. This was within the prostate fossa (PF) in 21.5\% (19/88), 13\% (12/91) and 19\% (6/31), with extra PF sites in 8\% (7/88), 19\% (17/91), and 32\% (10/31) for MRI, FCH and PSMA ({\ensuremath{<}} 0.004). 94\% (16/17) extra- PF sites on FCH were within the field of view of pelvic MRI. The detection rate for intrapelvic extra-PF disease was 90\% (9/10) for PSMA and 31\% (5/16) for MRI compared to FCH. Imaging changed expected management in 46\% (42/91) FCH, and 23\% (21/88) MRI. PSMA provided additive management change over FCH in a further 23\% (7/31). Treatment response to SRT was higher in men with negative or PF confined vs. extra PF disease. FCH 73\% (32/44) vs. 33\% (3/9) (p{\ensuremath{<}} 0.02), pelvic MRI 70\% (32/46) vs 50\% (2/4), P = ns) and PSMA 88\% (7/8) vs. 14\% (1/7) (p{\ensuremath{<}}0.005). Men with negative imging (MRI, FCH +/- PSMA) had high (78\%) response rates to SRT.

CONCLUSION: FCH and PSMA had high detection rates for extra PF disease in men with negative/equivocal conventional imaging and BCR post RP. This impacted management and treatment responses to SRT, suggesting an important role for PET in triaging men being considered for curative SRT.},
            issn = {1535-5667},
          author = {Emmett, L and Metser, U and Bauman, G and Hicks, RJ and Weickhardt, A and Davis, ID and Punwani, S and Pond, GR and Chua, SS-C and Ho, B and Johnston, E and Pouliot, F and Scott, A},
             url = {https://doi.org/10.2967/jnumed.118.220103}
}