[18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients

Abstract

FCH PET/CT is not likely to have a significant impact on the care of prostate cancer patients with biochemical recurrence until PSA increases to above 4 ng/ml. However, in selected patients, FCH PET/CT helps to exclude distant metastases when salvage local treatment is intended.

Incidental diagnosis of a PSA-negative prostate cancer by 18FDG PET/CT in a patient with hypopharyngeal cancer

“…12 Mainly 11 C-/ 18 F-choline and 11 C-/ 18 F-acetate seem to be of value for the named indications and superior to FDG-PET, especially in the diagnosis of primary PC. 6,12,[24][25][26][27][28][29][30] However, as in some studies, a differentiation between benign hyperplasia from cancerous lesions of the prostate gland was not possible with for example 18F-fluorocholine PET/CT imaging, all of these tracers still need clinical evaluation with regard to their diagnostic value in PC. 26 …”

18F-fluorocholine for prostate cancer imaging: a systematic review of the literature

“…Seven studies detailing the radiosynthesis of 18 F-FCH, preclinical and early clinical dosimetry and biodistribution in humans were identified. [20][21][22][23][24][25][26] Clinical studies included six articles for evaluation of local disease, [27][28][29][30][31][32] five articles for evaluation of nodal disease, 30,[33][34][35][36] six articles for bone metastases, including evaluation of treatment response, 30,34,[37][38][39][40] 12 articles for biochemical recurrence 34,[36][37][38][40][41][42][43][44][45][46][47] and two articles evaluating 18 F-FCH in castrate-resistant patients. 39,48 Seven studies evaluated 18 F-FCH for defining intra-prostatic lesions or limited lymph node recurrence for dose-escalated radiotherapy.…”

“…20,21,24,34,35,37,38,42,57 Early time points for imaging (0-15 min post-intravenous injection) and/or delayed imaging time points (30,40,45,60, 90-120 and 65-200 min post-intravenous injection) have been also described in the published literature. 22,23,[27][28][29][30][31][32][33]36,39,40,41,[43][44][45][46][47][48][49][50][51][52][54][55][56] 34 16…”

“…In patients with PSA o4 ng ml À1 and Gleason score 47, 18 F-FCH PET/CT was positive in 54% of patients. 41 Likewise, Pelosi et al 43 noted an overall detection rate of 42.9% in 24/56 patients with rising PSA post-prostatectomy, and noted an increase in positive 18 F-FCH scans with higher PSA at recurrence (20% at PSA o1ng ml À1 ; 44% at PSA ¼ 1-5 ng ml À1 ; 82% 18 F-fluorocholine for prostate cancer imaging G Bauman et al at PSA 45 ng ml À1 ). 43 In a series of 111 PCa patients including 68 patients with biochemical recurrence, 18 F-FCH imaging was able to detect local, nodal and bone recurrences.…”

“…In the setting of biochemical recurrence, generally the performance of 18 F-FCH PET/CT seems to be higher among patients with higher PSA at the time of recurrence, shorter PSA doubling time or higher initial Gleason grade. 34,[36][37][38][41][42][43][44][45][46][47] For instance, Cimitan et al 41 found positive 18 F-FCH scans in 54 patients examined for rising PSA post-radical prostatectomy (n ¼ 58), radical radiotherapy (n ¼ 21) or while on hormones (n ¼ 21). They noted that the 18 F-FCH scans were rarely (3/38) positive among patients with PSA o4 ng ml À1 and initial Gleason grade p7, whereas all patients with a PSA 44 ng ml À1 and Gleason score 47 had positive scans.…”