DOI: 10.1007/s00259-018-3944-0Pages: 962-969

The relationship between local recurrences and distant metastases in prostate cancer: can 11C-choline PET/CT contribute to understand the link?

1. S. Andrea Hospital, Department of Nuclear Medicine

2. IRCCS San Raffaele Scientific Institute, Department of Radiation Therapy

3. IRCCS San Raffaele Scientific Institute, Department of Nuclear Medicine

4. Vita-Salute San Raffaele University

Correspondence to:
Maria Picchio
Tel: +39 02 2643 6117




Previous studies in prostate cancer (PCa) patients tried to correlate the onset of local recurrence (LR) with the development of distant metastases and formulated, based on theoretical and experimental data, hypotheses linking the two events. We aimed to address this issue with 11C-choline positron emission tomography/computed tomography (PET/CT).


This retrospective study included 491 PCa patients previously treated with radical prostatectomy who had undergone 11C-choline PET/CT owing to biochemical failure. Further inclusion criteria were availability of clinical and pathological variables for survival analysis. Statistical significance was taken at P < 0.05.


Seventy-two patients (14.7%) had evidence of LR at 11C-choline PET/CT. The frequency of LR increased from 13.8% in the interval 0–4 years after prostatectomy, to 23.9% in the 12–16-year interval (P = 0.080). On the contrary, the frequency of lymph node metastases (overall rate in the 0–16 years interval after prostatectomy: 26.3%) and of bone metastases (overall rate: 13.8%) decreased significantly over time. Kaplan-Meier curves showed no significant group difference in the rates of lymph node or bone metastases between patients with LR and patients without LR. LR significantly predicted PCa-specific survival at univariate analysis, but the statistical significance was lost at multivariate analysis.


We found no differences in the rates of lymph node and bone metastases between patients with and without LR. An inverse time-dependent trend was observed in the frequency of LR on one side and of lymph node and bone metastases on the other side. These findings were discussed in relation to previous theories linking LR to distant metastases and our study design.

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  • Accepted: Jan 11, 2018
  • Online: Feb 16, 2018

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