Fluorocholine PET/CT in Patients with Prostate Cancer: Initial Experience

Abstract

Institutional review board approval and written informed consent were obtained. Patients with newly diagnosed prostate cancer and patients suspected of having recurrent prostate cancer were prospectively evaluated with fluorine 18 fluorocholine (FCH) combined in-line positron emission tomography (PET) and computed tomography (CT). In 19 patients (mean age, 67 years +/- 8; range, 57-85 years), standardized uptake values of FCH in 17 different tissues were determined by using volumes of interest. In nine patients evaluated at initial staging, histologic findings of the resected prostate were compared to FCH uptake. Only small variations of physiologic tracer accumulation were measured in all organs but the kidneys. Differentiation of benign hyperplasia from cancerous prostate lesions was not possible with FCH PET/CT. However, in patients with recurrent prostate cancer, FCH PET/CT is a promising imaging modality for detecting local recurrence and lymph node metastases.

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…”

“…Likewise, Beheshti et al 30 noted a good correlation (r ¼ 0.68; Po0.001) between sextants with maximum 18 F-FCH uptake and sextants with maximum tumor burden on radical prostatectomy specimens in a large series (n ¼ 130) of intermediateand high-risk patients pre-prostatectomy (Figure 2). In comparison, among nine PCa patients with PSA X20 ng ml À1 and positive prostate biopsy, Schmid et al 32 found only one patient with focal 18 F-FCH uptake that correlated with the location of prostate cancer identified post-operatively on the radical prostatectomy specimen. The remaining eight patients had heterogeneous 18 F-FCH uptake that tended to correlate with regions of BPH.…”

“…The remaining eight patients had heterogeneous 18 F-FCH uptake that tended to correlate with regions of BPH. 32 Similarly, among 20 patients with persistently elevated PSA and repeated negative prostate biopsy, Igerc et al 31 noted 18 F-FCH focal uptake in 13/20 patients, but F-FCH PET/CT was positive, while sentinel lymph node detection was falsely negative. 35 Husarik et al 36 also noted a low sensitivity for nodal detection (20%) among 43 PCa men evaluated preoperatively.…”