11C-Choline PET/CT and PSA kinetics

  • Paolo CastellucciEmail author
  • Maria Picchio
Review Article


The role of PET/CT with radiolabelled 18F-choline or 11C-choline in patients with prostate cancer after primary treatment has not been established yet and there are no guidelines on the appropriate use of this emerging modality. According to the literature, choline PET/CT may have a role in restaging the disease in patients with biochemical relapse for the detection of local and/or lymph node and/or distant recurrence. The aim of this brief review is to summarize the results of the most relevant published studies with particular focus on the relationship between prostate-specific antigen levels and kinetics and the sensitivity of choline PET/CT for optimizing the selection of patients who may benefit the most from this diagnostic procedure, especially early after biochemical recurrence.


Prostate cancer Choline, PET/CT PSA kinetics 


Conflicts of interest



  1. 1.
    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
  2. 2.
    Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, Mason MD et al. Guidelines on prostate cancer. Arnhem: European Association of Urology; 2012.Google Scholar
  3. 3.
    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
  4. 4.
    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.CrossRefGoogle Scholar
  5. 5.
    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;160:387–91.CrossRefGoogle Scholar
  6. 6.
    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
  7. 7.
    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(6 Pt 1):2260–4.PubMedCrossRefGoogle Scholar
  8. 8.
    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
  9. 9.
    Farsad M, Schiavina R, Castellucci P, Nanni C, Corti B, Martorana G, et al. 11C-choline positron emission tomography/computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: comparison with clinical staging nomograms. Detection and localization of prostate cancer: correlation of 11C-choline PET/CT with histopathologic step-section analysis. J Nucl Med. 2005;46:1642–9.Google Scholar
  10. 10.
    Schiavina R, Scattoni V, Castellucci P, Picchio M, Corti B, Briganti A, et al. 11C-choline positron emission tomography/computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: comparison with clinical staging nomograms. Eur Urol. 2008;54:392–401.PubMedCrossRefGoogle Scholar
  11. 11.
    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
  12. 12.
    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
  13. 13.
    Giovacchini G, Picchio M, Coradeschi E, Bettinardi V, Gianolli L, Scattoni V, et al. Predictive factors of [11C]Choline PET/CT in patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2010;37:301–9.PubMedCrossRefGoogle Scholar
  14. 14.
    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(9):1394–400.PubMedCrossRefGoogle Scholar
  15. 15.
    Giovacchini G, Picchio M, Scattoni V, Garcia Parra R, Briganti A, Gianolli L, et al. PSA doubling time for prediction of 11C 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
  16. 16.
    Castellucci P, Fuccio C, Rubello D, Schiavina R, Santi I, Nanni C, et al. Is there a role for 11C-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
  17. 17.
    Breeuwsma AJ, Rybalov M, Leliveld AM, Pruim J, de Jong IJ. Correlation of [11C]choline PET-CT with time to treatment and disease-specific survival in men with recurrent prostate cancer after radical prostatectomy. Q J Nucl Med Mol Imaging. 2012;56:440–6.PubMedGoogle Scholar
  18. 18.
    Rybalov M, Breeuwsma AJ, Leliveld AM, Pruim J, Dierckx RA, de Jong IJ. Impact of total PSA, PSA doubling time and PSA velocity on detection rates of 11C-Choline positron emission tomography in recurrent prostate cancer. World J Urol. 2012. doI: 10.1007/s00345-012-0908-z.
  19. 19.
    Schillaci O, Calabria F, Tavolozza M, Caracciolo CR, Finazzi Agrò E, et al. Influence of PSA, PSA velocity and PSA doubling time on contrast-enhanced 18F-choline PET/CT detection rate in patients with rising PSA after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2012;39:589–96.PubMedCrossRefGoogle Scholar
  20. 20.
    Graute V, Jansen N, Ubleis C, Seitz M, Hartenbach M, Scherr MK, et al. Relationship between PSA kinetics and [18F]fluoro-choline PET/CT detection rates of recurrence in patients with prostate cancer after total prostatectomy. Eur J Nucl Med Mol Imaging. 2012;39:271–82.PubMedCrossRefGoogle Scholar
  21. 21.
    National Collaborating Centre for Cancer. Managing relapse after radical treatment. In Prostate cancer: diagnosis and treatment. Chap 5. Cardiff: National Collaborating Centre for Cancer; 2008. p. 42–8. Available from:
  22. 22.
    Scattoni V, Roscigno M, Raber M, Montorsi F, Da Pozzo L, Guazzoni G, et al. Multiple vesico-urethral biopsies following radical prostatectomy: the predictive roles of TRUS, DRE, PSA and the pathological stage. Eur Urol. 2003;44:407–14.PubMedCrossRefGoogle Scholar
  23. 23.
    Picchio M, Briganti A, Fanti S, Heidenreich A, Krause BJ, Messa C, et al. The role of positron emission tomography/computed tomography in the management of patients with prostate-specific antigen progression after radical treatment of prostate cancer. Eur Urol. 2011;59:51–60.PubMedCrossRefGoogle Scholar
  24. 24.
    D’Amico AV, Moul JW, Carroll PR, Sun L, Lubeck D, Chen MH. Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst. 2003;95:1376–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Sandler HM, Dunn RL, McLaughlin PW, Hayman JA, Sullivan MA, Taylor JM. Overall survival after prostate-specific-antigen-detected recurrence following conformal radiation therapy. Int J Radiat Oncol Biol Phys. 2000;48:629–33.PubMedCrossRefGoogle Scholar
  26. 26.
    Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC, et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA. 2005;294:433–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Ratib O. PET/MRI: a new era in multimodality molecular imaging. Clin Transl Imaging. 2013. doi: 10.1007/s40336-013-0003-5
  28. 28.
    Soyka JD, Muster MA, Schmid DT, Seifert B, Schick U, Miralbell R, et al. Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2012;39:936–43.PubMedCrossRefGoogle Scholar
  29. 29.
    Picchio M, Giovannini E, Crivellaro C, Gianolli L, di Muzio N, Messa C. Clinical evidence on PET/CT for radiation therapy planning in prostate cancer. Radiother Oncol. 2010;96:347–50.PubMedCrossRefGoogle Scholar
  30. 30.
    Cochet A, Rousseau C, Dewas S, Supiot S, Brunotte F, Truc G. FluoroCholine(18F) (FCH) PET/CT for guiding image-guided salvage intensity-modulated radiation therapy (IG-sIMRT) in occult recurrence of prostate cancer: initial experience. Eur J Nucl Med Mol Imaging. 2010;37 Suppl 2:OP336.Google Scholar
  31. 31.
    Souvatzoglou M, Krause BJ, Pürschel A, Thamm R, Schuster T, Buck AK, et al. Influence of 11C-choline PET/CT on the treatment planning for salvage radiation therapy in patients with biochemical recurrence of prostate cancer. Radiother Oncol. 2011;99:193–200.PubMedCrossRefGoogle Scholar
  32. 32.
    Petersen C, Wahl A, Dahle J, Kretschmer M. [18F]fluoroethylcholine-PET/CT imaging for radiation treatment planning of recurrent and primary prostate cancer with dose escalation to PET/CT-positive lymph nodes. Radiat Oncol. 2011;6:44.PubMedCrossRefGoogle Scholar
  33. 33.
    Di Muzio N, Fodor A, Berardi G, Mapelli P, Gianolli L, Messa C, et al. Lymph nodal metastases: diagnosis and treatment. Q J Nucl Med Mol Imaging. 2012;56:421–9.PubMedGoogle Scholar
  34. 34.
    Rigatti P, Suardi N, Briganti A, Da Pozzo LF, et al. Pelvic/retroperitoneal salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography. Eur Urol. 2011;60(5):935–43. doi: 10.1016/j.eururo.2011.07.060.PubMedCrossRefGoogle Scholar
  35. 35.
    Pace L, Nicolai E, Aiello M, Catalano OA, Salvatore M. Whole Body PET/MRI in oncology: current status and clinical application. Clin Transl Imaging. 2013; in pressGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Nuclear Medicine UnitPoliclinico S. Orsola-Malpighi, University of BolognaBolognaItaly
  2. 2.Nuclear Medicine Unit, San Raffaele Scientific Institute, Institute for Bioimaging and Molecular PhysiologyNational Research Council (IBFM-CNR)MilanItaly
  3. 3.UO di Medicina Nucleare, PAD. 30Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-MalpighiBolognaItaly

Personalised recommendations