[18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients
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We evaluated the potential of PET/CT and [18F]fluoromethylcholine (FCH) in the assessment of suspected recurrence of prostate cancer after treatment.
One hundred consecutive prostate cancer patients with a persistent increase in serum PSA (>0.1 ng/ml) after radical prostatectomy (58 cases), radiotherapy (21 cases) or hormonal therapy alone (21 cases) were investigated. After injection of 3.7–4.07 MBq/kg of FCH, both early (at <15 min) and delayed (at >60 min) PET/CT scans were performed in 43 patients, delayed PET/CT scans in 53 patients and early PET/CT scans in four patients.
Of the 100 patients, 54 (PSA 0.22–511.79 ng/ml) showed positive FCH PET/CT scans. Thirty-seven patients had bone and/or abdominal lymph node uptake, while 17 showed pelvic activity. Malignant disease was confirmed in all but one. Delayed SUVmax of bone metastases was significantly higher (p<0.0001 by paired t test) than that measured at <15 min, whereas no differences were observed between early and delayed SUVs of malignant lymph nodes or pelvic disease. Forty-six patients (PSA 0.12–14.3 ng/ml) showed negative FCH PET/CT scans. Of the negative PET/CT scans, 89% were obtained in patients with serum PSA <4 ng/ml and 87% in patients with a Gleason score <8. In none of these cases could recurrent tumour be proven clinically during a follow-up of 6 months.
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.
KeywordsCholine PET Prostate cancer
We would like to thank Cassa di Risparmio di Udine e Pordenone and Acropolis Foundations for their generous donation of the CT equipment of the PET/CT scanner.
- 2.Loblaw A, Mendelson D, Talcott J, Virgo K, Somerfield M, Ben-Josef E, et al. American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer. J Clin Oncol 2004;22:2927–2941PubMedCrossRefGoogle Scholar
- 5.Parivar F, Hricak H, Shinohara K, Kurhanewicz J, Vigneron DB, Nelson SJ, et al. Detection of locally recurrent prostate cancer after cryosurgery: evaluation by transrectal ultrasound, magnetic resonance imaging, and three-dimensional proton magnetic resonance spectroscopy. Urology 1996;48:594–599PubMedCrossRefGoogle Scholar
- 24.De Grado T, Coleman R, Wang S, Baldwin S, Orr M, Robertson C, et al. Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res 2001;61:110–117Google Scholar
- 27.De Grado T, Reiman R, Price D, Wang S, Coleman R. Pharmacokinetics and radiation dosimetry of 18F-fluorocholine. J Nucl Med 2002;43:92–96Google Scholar
- 35.Hara T, Yuasa M. Automated synthesis of fluorine-18 labeled choline analogue: 2-fluoroethyl-dimethyl-2oxyethylammonium [abstract]. J Nucl Med 1997;38(suppl):44PGoogle Scholar
- 37.De Grado T, Baldwin R, Wang S, Orr M, Liao R, Friedman H, et al. Synthesis and evaluation of 18F-labeled choline analogs as oncologic PET tracers. J Nucl Med 2001;42:1805–1814Google Scholar