Feis, V.B. (2013) Voorspellende Waarde van 11C-choline PET/CT voor Progressievrije Overleving bij Patiënten met Recidief Prostaatcarcinoom Behandeld met Cryoablatie na Radiotherapie. thesis, Medicine.
Full text available on request.Abstract
INTRODUCTION: Prostate carcinoma is a common disease with high mortality, prevalence will increase due to heightened aging of the general population in the Netherlands. Besides surgical, radio therapeutic and medicinal approaches, new local treatments like cryoablation are in development. Patients with recurrent PCa after primary treatment with radiotherapy may be eligible for a second bout of curative therapy, provided that the PCa meets ≤T3N0M0. No strict guideline for restaging recurrent PCa primary treated with radiotherapy has been determined to date. There is need for a new diagnostic tool. Recent research shows promising results for 11C-choline PET/CT as a tool for restaging a recurrent PCa. This project compares if progression free survival (PFS) of patients staged with 11C-choline PET/CT and treated with cryoablation is better than patients staged with conservative diagnostics and treated with cryoablation. MATERIAL AND METHODS: In this multicenter single arm retrospective 5-year observational cohort study, 61 patients with suggested recurrent PCa underwent 11C-choline PET/CT for staging. Patients originated from five Dutch hospitals. Eventually 40 patients had a local recurrence and were candidates for cryoablation, the other 21 patients were referred back to their treating urologist for (palliative) treatment. After cryoablation follow-up was monitored and PFS was calculated, a biochemical failure (BF) was diagnosed with the so called Phoenix criteria, PSA rise of >2,0ng/ml compared to PSA nadir. Statistical analyses were performed, with SPSS, to determine the applied value of the 11C-choline PET/CT in this specific patient population. RESULTS: Mean age was 69 years, 38 patients were analyzed. A total of 9 (23,7%) patients had a BF (mean follow-up 28,18 months). 15 (39,5%) patients had symptoms after cryoablation, varying from LUTS to heavy incontinence, which 5 of the patients had. The study population was divided in two categories: cryablation with PSA-value <4,0ng/ml and cryoablation with PSA ≥4,0ng/ml. In the category with PSA-values <4,0ng/ml no BF occurred. Category PSA-values ≥4,0ng/ml had all cases of BF. The group with PSA-values >4,0ng/ml had slighty more urogenital symptoms. 5 of the patients with BF had rapid rising of PSA post-cryoablation, probably bases on metastases. CONCLUSION: Patients with recurrent PCa staged with 11C-choline PET/CT have longer PFS after cryoablation in comparison to patients staged with conventional diagnostics. The predictive value of 11C-choline PET/CT is small but surpasses the performance outcome of conventional diagnostics. A serum PSA-value of <4,0ng/ml as selection criterion for cryoablation leads to significantly longer PFS after cryoablation. Addition of 11C-choline PET/CT to the selection criteria gives further improvement of PFS and is financially feasible. 11C-choline PET/CT has applied value. Cryoablation performs well as a salvage treatment in field of efficacy, patient survival and applicability. Cryoablation compares well in relation to other salvage therapies. The results of this project justify further research in this area.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | DIRECTE BEGELEIDER: and BREEUWSMA, A.J. MD and FACULTAIR BEGELEIDER: and JONG, I.J. DE MD and INSTELLING: UNIVERSITAIR MEDISCH CENTRUM GRONINGEN, AFDELING |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:46 |
| Last Modified: | 25 Jun 2020 10:46 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/781 |
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