F-choline PET in Early Response Assessment for Castration Resistant Prostatic Cancer

Until today no current diagnostic tool exists to identify an early objective response when patients with castration-resistant prostate cancer were treated by abiraterone acetate or enzalutamide. According to the Prostate Cancer Working Group, the investigators have to wait 12 weeks before the first evaluation. To know soon that the treatment is effective will be decisive for the oncologist, even more in palliative situation where second effects can't be imposed to patients. In post-docetaxel, the F-choline PET-CT could be used to assess the response of this new therapy. Moreover, the investigators suppose that we can assess an early stage if there is an objective therapeutic response, at 6 weeks of treatment, in order to avoid unnecessarily and expansive treatment. The aim of this study is to assess if it is possible to determine early (6 weeks of treatment)if a F-choline PET-CT could predict the response to abiraterone acetate or enzalutamide in post-docetaxel.

Sex

Male

Minimum age

18 Years

Inclusion Criteria:

* Age \> 18 years
* Eastern Cooperative Oncology Group (ECOG)performance status score of 2 or less
* Histologically or cytologically confirmed adenocarcinoma prostate cancer without neuroendocrine component (component with minority neuroendocrine) or small cell, or neuroendocrine cells or small minority component prostate who underwent surgical or medical castration
* Disease progression during or after a docetaxel-based chemotherapy
* serum testosterone level of 50 ng per deciliter or less (≤2.0 nmol per liter)
* Biologic criteria :
* platelets ≥ 100 000/μl,
* Creatinine \<1.5 x upper limit or creatinine clearance ≥ 60 ml / min,
* Serum potassium ≥ 3.5 mmol / l,
* Bilirubin \<1.5 x upper limit of normal (ULN)
* hemoglobin ≥ 9.0 g / dl without any transfusion.

Exclusion Criteria:

* abnormal aminotransferase levels (levels of aspartate aminotransferase or alanine aminotransferase that were ≥2.5 times the upper level of the normal range; patients with known liver metastasis who had levels of aspartate aminotransferase or alanine aminotransferase that were ≤5 times the upper level of the normal range were eligible to participate
* previous therapy with ketoconazole
* serious coexisting nonmalignant disease :
* active or symptomatic viral hepatitis or chronic liver disease,
* uncontrolled hypertension,
* a history of pituitary or adrenal dysfunction,
* clinically significant heart disease

• BACKGROUNDJemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ. Cancer statistics, 2008. CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96. doi: 10.3322/CA.2007.0010. Epub 2008 Feb 20. PMID 18287387
• BACKGROUNDTownsend DW. Dual-modality imaging: combining anatomy and function. J Nucl Med. 2008 Jun;49(6):938-55. doi: 10.2967/jnumed.108.051276. Epub 2008 May 15. PMID 18483101
• BACKGROUNDJadvar H. Prostate cancer: PET with 18F-FDG, 18F- or 11C-acetate, and 18F- or 11C-choline. J Nucl Med. 2011 Jan;52(1):81-9. doi: 10.2967/jnumed.110.077941. Epub 2010 Dec 13. PMID 21149473
• BACKGROUNDde Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJ. 11C-choline positron emission tomography for the evaluation after treatment of localized prostate cancer. Eur Urol. 2003 Jul;44(1):32-8; discussion 38-9. doi: 10.1016/s0302-2838(03)00207-0. PMID 12814672
• BACKGROUNDScattoni V, Picchio M, Suardi N, Messa C, Freschi M, Roscigno M, Da Pozzo L, Bocciardi A, Rigatti P, Fazio F. Detection of lymph-node metastases with integrated [11C]choline PET/CT in patients with PSA failure after radical retropubic prostatectomy: results confirmed by open pelvic-retroperitoneal lymphadenectomy. Eur Urol. 2007 Aug;52(2):423-9. doi: 10.1016/j.eururo.2007.03.032. Epub 2007 Mar 20. PMID 17397992
• BACKGROUNDRinnab L, Mottaghy FM, Blumstein NM, Reske SN, Hautmann RE, Hohl K, Moller P, Wiegel T, Kuefer R, Gschwend JE. Evaluation of [11C]-choline positron-emission/computed tomography in patients with increasing prostate-specific antigen levels after primary treatment for prostate cancer. BJU Int. 2007 Oct;100(4):786-93. doi: 10.1111/j.1464-410X.2007.07083.x. PMID 17822459
• BACKGROUNDGiovacchini G, Picchio M, Coradeschi E, Bettinardi V, Gianolli L, Scattoni V, Cozzarini C, Di Muzio N, Rigatti P, Fazio F, Messa C. Predictive factors of [(11)C]choline PET/CT in patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2010 Feb;37(2):301-9. doi: 10.1007/s00259-009-1253-3. Epub 2009 Sep 15.