Detection of a second malignancy in prostate cancer patients by using [18F]Choline PET/CT: a case series

Abstract

BackgroundThe role of radiolabeled choline (Cho) in patients with biochemical recurrence after radical treatment for prostate cancer (PCa) is well established. Its widespread clinical use has prompted the depiction of incidentalomas, unusual sites of metastatic lesions, as well as false positive and negative cases. We reported a series of patients affected by biochemical recurrence of PCa imaged by [18F]Cho positron emission tomography/computed tomography (PET/CT) which resulted suspected for a second malignancy.Case presentation[18F]Cho PET/CT was performed in patients with biochemical PCa recurrence. From an internal clinical database we identified patients in which PET/CT resulted suspected for a second malignancy. A second malignancy was suspected in presence of “unusual” site of [18F]Cho uptake not consistent with clinical-instrumental history. Histology was used as reference standard for final diagnosis.Seven PCa patients (76 years, 71–84 years) with the suspicion of a second tumor based on [18F]Cho PET/CT findings were identified. Mean value of PSA at the time of [18F]Cho PET/CT was 2,37 ng/mL. The median time between PCa diagnosis and PET/CT was 6 years (range 0–14 years). In two cases history of a second malignancy (lung cancer and cutaneous basocellular carcinoma) was known (diagnosed 12 and 6 years after PCa, respectively). PET/CT identified 13 sites of [18F]Cho uptake (lung = 5, lymph node = 7, bone = 1). Final diagnosis was consistent with lung cancer in 5/7 cases (first diagnosis = 4/5, recurrence = 1/5), colorectal cancer and nodal metastases from melanoma in 1 case each.ConclusionsAlthough the clinical usefulness of Cho PET/CT for detecting cancer lesions other than prostate origin is known, for those patients who undergo this examination according to indication, the diagnosis of a second tumor has a significant impact on their therapeutic management.

Osteoblastic bone metastases from neuroendocrine tumor (NET) of unknown origin detected by 18fluorocholine PET/CT and its comparison with 68gallium-DOTATOC PET/CT

“…[ 12 , 15 ] Numerous case reports and clinical studies have also been published on 18 F-CH PET/CT positivity in other solid tumors. [ 13 , 22 ] In a recent paper by Sollini et al, [ 23 ] 7 patients with biochemical prostate cancer recurrence underwent 18 F-CH PET/CT and positive lesions were biopsied. Lung cancer was found in 5 patients, colorectal cancer in 1 patient, and lymph node metastases from melanoma in 1 patient.…”

Unusual uptakes on 18F-fluorocholine positron emission tomography/computed tomography (PET/CT): a retrospective study of 368 prostate cancer patients referred for a biochemical recurrence or an initial staging

“…Unusual uptakes on 18 F-fluorocholine positron emission tomography/computed tomography (PET/CT): a retrospective study of 368 prostate cancer patients referred for a biochemical recurrence or an initial staging with 18 F-fluorocholine (F-choline) or, more recently, 68 Gaprostate-specific membrane antigen (PSMA) PET/CT, plays a key role in distinguishing a local recurrence from a systemic spread of the disease, in order to optimize the therapeutic strategy (5,6). In fact, it has been shown that the results of PET/CT could influence patient's management in more than half cases (7)(8)(9).…”

“…Finally, increased choline kinase activity has been demonstrated in a wide variety of human malignancies (10,14) such as PCa (5,15), hepatocellular carcinoma (16) or bronchioloalveolar lung cancer (17). Currently only a few large series investigated the potential of F-choline PET/CT to detect second malignancies in patients referred for the staging of a PCa (14,18).…”

“…For two patients, lung cancer was already diagnosed at the time of the PET/ CT procedure, so these patients cannot be considered as true incidental findings. For the other two patients, lung cancer was revealed by 18 F-fluorocholine PET/CT.…”

Response to: Positron emission tomography/computed tomography with 18 F-fluorocholine improve tumor staging and treatment allocation in patients with hepatocellular carcinoma

“…Several other tumour types are known to accumulate either 18F-FDG or 18 F-FCH, for example bronchus carcinoma and prostate cancer. 6 At present, PET/ CT is not able to distinguish between different histological origins. Therefore, histopathologic confirmation of extrahepatic and especially osseous lesions with high tracer accumulation remains necessary for correct clinical decision making.…”