Androgen deprivation therapy influences the uptake of 11C-choline in patients with recurrent prostate cancer: the preliminary results of a sequential PET/CT study

  • Chiara Fuccio
  • Riccardo Schiavina
  • Paolo Castellucci
  • Domenico Rubello
  • Giuseppe Martorana
  • Monica Celli
  • Claudio Malizia
  • Marta Barios Profitos
  • Maria Cristina Marzola
  • Vincenzina Pettinato
  • Stefano Fanti
Short Communication



The influence of androgen deprivation therapy (ADT) on 11C-choline uptake in patients with prostate cancer (PC) has not yet been clarified. The aim of our study was to investigate this issue by means of sequential 11C-choline positron emission tomography (PET)/CT in patients with recurrent PC.


We retrospectively studied 14 recurrent PC patients (mean age 67 years, range 55–82) during follow-up after radical prostatectomy (RP) with rising serum prostate-specific antigen (PSA) levels. All patients had undergone at least two consecutive 11C-choline PET/CT scans: the first 11C-choline PET/CT before commencing ADT and the second 11C-choline PET/CT after 6 months of ADT administration.


The mean serum PSA level before ADT was 17.0 ± 44.1 ng/ml. After 6 months of ADT administration the PSA value significantly decreased in comparison to baseline (PSA = 2.4 ± 3.1 ng/ml, p < .025). Moreover, before starting ADT, 13 of 14 patients had positive 11C-choline PET/CT for metastatic spread, while after 6 months of ADT administration in 9 of 14 patients 11C-choline PET/CT became negative.


These preliminary results suggest that ADT significantly reduces 11C-choline uptake in androgen-sensitive PC patients.


Sequential choline PET/CT Prostate cancer Recurrent disease Androgen deprivation therapy 


Conflicts of interest



  1. 1.
    Boorjian SA, Thompson RH, Tollefson MK, Rangel LJ, Bergstralh EJ, Blute ML, et al. Long-term risk of clinical progression after biochemical recurrence following radical prostatectomy: the impact of time from surgery to recurrence. Eur Urol 2011;59:893–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Kataja VV, Bergh J. ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of prostate cancer. Ann Oncol 2005;16 Suppl 1:i34–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Flüchter SH, Weiser R, Gamper C. The role of hormonal treatment in prostate cancer. Recent Results Cancer Res 2007;175:211–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Naya Y, Okihara K, Evans RB, Babaian RJ. Efficacy of prostatic fossa biopsy in detecting local recurrence after radical prostatectomy. Urology 2005;66:350–5.PubMedCrossRefGoogle Scholar
  5. 5.
    De Visschere PJ, De Meerleer GO, Fütterer JJ, Villeirs GM. Role of MRI in follow-up after focal therapy for prostate carcinoma. AJR Am J Roentgenol 2010;194:1427–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Choueiri TK, Dreicer R, Paciorek A, Carroll PR, Konety B. A model that predicts the probability of positive imaging in prostate cancer cases with biochemical failure after initial definitive local therapy. J Urol 2008;179:906–10.PubMedCrossRefGoogle Scholar
  7. 7.
    Cher ML, Bianco Jr FJ, Lam JS, Davis LP, Grignon DJ, Sakr WA, et al. Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy. J Urol 1998;160:1387–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Gomez P, Manoharan M, Kim SS, Soloway MS. Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated? BJU Int 2004;94:299–302.PubMedCrossRefGoogle Scholar
  9. 9.
    Okotie OT, Aronson WJ, Wieder JA, Liao Y, Dorey F, DeKernion JB, et al. Predictors of metastatic disease in men with biochemical failure following radical prostatectomy. J Urol 2004;171:2260–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Picchio M, Messa C, Landoni C, Gianolli L, Sironi S, Brioschi M, et al. Value of [11C]choline-positron emission tomography for re-staging prostate cancer: a comparison with [18F]fluorodeoxyglucose-positron emission tomography. J Urol 2003;169:1337–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Fuccio C, Rubello D, Castellucci P, Marzola MC, Fanti S. Choline PET/CT for prostate cancer: main clinical applications. Eur J Radiol 2010. [Epub ahead of print].Google Scholar
  12. 12.
    Tyrrell CJ, Payne H, See WA, McLeod DG, Wirth MP, Iversen P, et al. Bicalutamide (‘Casodex’) 150 mg as adjuvant to radiotherapy in patients with localised or locally advanced prostate cancer: results from the randomised Early Prostate Cancer Programme. Radiother Oncol 2005;76:4–10.PubMedCrossRefGoogle Scholar
  13. 13.
    Mottet N, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2011;59:572–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Giovacchini G, Picchio M, Coradeschi E, Scattoni V, Bettinardi V, Cozzarini C, et al. [(11)C]choline uptake with PET/CT for the initial diagnosis of prostate cancer: relation to PSA levels, tumour stage and anti-androgenic therapy. Eur J Nucl Med Mol Imaging 2008;35:1065–73.PubMedCrossRefGoogle Scholar
  15. 15.
    Pascali C, Bogni A, Iwata R, Cambiè M, Bombardieri E. [11C]Methylation on a C18 Sep-Pak cartridge: a convenient way to produce [N-methyl-11C]choline. J Labelled Comp Radiopharm 2000;43:195–203.CrossRefGoogle Scholar
  16. 16.
    Fanti S, Nanni C, Ambrosini V, Gross MD, Rubello D, Farsad M. PET in genitourinary tract cancers. Q J Nucl Med Mol Imaging 2007;51:260–71.PubMedGoogle Scholar
  17. 17.
    Apolo AB, Pandit-Taskar N, Morris MJ. Novel tracers and their development for the imaging of metastatic prostate cancer. J Nucl Med 2008;49:2031–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Krause BJ, Souvatzoglou M, Tuncel M, Herrmann K, Buck AK, Praus C, et al. The detection rate of [(11)C]choline-PET/CT depends on the serum PSA-value in patients with biochemical recurrence of prostate cancer. Eur J Nucl Med Mol Imaging 2008;35:18–23.PubMedCrossRefGoogle Scholar
  19. 19.
    Castellucci P, Fuccio C, Nanni C, Santi I, Rizzello A, Lodi F, et al. Influence of trigger PSA and PSA kinetics on 11C-choline PET/CT detection rate in patients with biochemical relapse after radical prostatectomy. J Nucl Med 2009;50:1394–400.PubMedCrossRefGoogle Scholar
  20. 20.
    Giovacchini G, Picchio M, Coradeschi E, Bettinardi V, Gianolli L, Scattoni V, et al. Predictive factors of [(11)C]choline PET/CT in patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging 2010;37:301–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Giovacchini G, Picchio M, Scattoni V, Garcia Parra R, Briganti A, Gianolli L, et al. PSA doubling time for prediction of [(11)C]choline PET/CT findings in prostate cancer patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging 2010;37:1106–16.PubMedCrossRefGoogle Scholar
  22. 22.
    Castellucci P, Fuccio C, Rubello D, Schiavina R, Santi I, Nanni C, et al. Is there a role for (11)C-choline PET/CT in the early detection of metastatic disease in surgically treated prostate cancer patients with a mild PSA increase <1.5 ng/ml? Eur J Nucl Med Mol Imaging 2011;38:55–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Podo F. Tumour phospholipid metabolism. NMR Biomed 1999;12:413–39.PubMedCrossRefGoogle Scholar
  24. 24.
    Breeuwsma AJ, Pruim J, Jongen MM, Suurmeijer AJ, Vaalburg W, Nijman RJ, et al. In vivo uptake of [11C]choline does not correlate with cell proliferation in human prostate cancer. Eur J Nucl Med Mol Imaging 2005;32:668–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Al-Saeedi F, Welch AE, Smith TA. [methyl-3H]Choline incorporation into MCF7 tumour cells: correlation with proliferation. Eur J Nucl Med Mol Imaging 2005;32:660–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Al-Saeedi F, Smith T, Welch A. [Methyl-3H]-choline incorporation into MCF-7 cells: correlation with proliferation, choline kinase and phospholipase D assay. Anticancer Res 2007;27:901–6.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Chiara Fuccio
    • 1
  • Riccardo Schiavina
    • 2
  • Paolo Castellucci
    • 1
  • Domenico Rubello
    • 3
    • 5
  • Giuseppe Martorana
    • 2
  • Monica Celli
    • 1
  • Claudio Malizia
    • 1
  • Marta Barios Profitos
    • 4
  • Maria Cristina Marzola
    • 3
  • Vincenzina Pettinato
    • 1
  • Stefano Fanti
    • 1
  1. 1.Department of Nuclear Medicine, PAD. 30, Sant’Orsola-Malpighi HospitalUniversity of BolognaBolognaItaly
  2. 2.Department of Urology, Sant’Orsola-Malpighi HospitalUniversity of BolognaBolognaItaly
  3. 3.Department of Nuclear MedicineSanta Maria della Misericordia HospitalRovigoItaly
  4. 4.Servei Medicina Nuclear Hospital, Vall D’HebronBarcelonaSpain
  5. 5.Department of Nuclear Medicine, Radiology, Medical Physics, Service of Nuclear Medicine, PET/CT CentreS. Maria della Misericordia HospitalRovigoItaly

Personalised recommendations