Molecular Imaging and Biology

, Volume 8, Issue 1, pp 43–48

Positron Emission Tomography/Computed Tomography with F-18-fluorocholine for Restaging of Prostate Cancer Patients: Meaningful at PSA < 5 ng/ml?

  • Martin Heinisch
  • Albert Dirisamer
  • Wolfgang Loidl
  • Franz Stoiber
  • Bernhard Gruy
  • Silke Haim
  • Werner Langsteger
Original Article

Abstract

 

According to reports, re-staging of patients suffering from prostate cancer by positron emission tomography (PET) using C-11-choline has failed to produce positive findings at a PSA level of < 5 ng/ml. Hence, the purpose of our study has been to determine whether this is true also for PET/CT using F-18-fluorocholine (FCH PET/CT) or whether it is possible to obtain true positive results by FCH PET/CT even at lower PSA levels.

Methods

In 34 patients with prostate cancer who had undergone initial therapy (radical prostatectomy n = 31, radiotherapy n = 3), a PET/CT scan was performed using F-18-fluorocholine (FCH) during follow-up in case of demonstrable or rising PSA levels. Current PSA levels were determined in all patients at the time of examination.

Results

Median PSA in FCH positive patients was 6.1 ng/ml (mean PSA 17.1 ng/ml), median PSA in FCH negative patients was 2.3 ng/ml (mean PSA 3.4 ng/ml), respectively (p < 0.05). In eight of 17 examinations (47%) with PSA < 5 ng/ml, at least one FCH-positive focus was detected. So far the findings could be confirmed by correlating imaging methods (CT and/or MR), biopsy/histology and the course of the disease, respectively, in seven of the eight FCH-positive cases with PSA < 5 ng/ml, so that a true positive FCH PET/CT finding was obtained all in all in seven of 17 (41%) examinations with PSA < 5 ng/ml. In four of these seven FCH PET-positive patients with PSA < 5 ng/ml, adjuvant hormonal therapy was administered at the time of the examination or prior to the examination.

Conclusion

In re-staging patients with prostate cancer, FCH PET/CT is able to yield true positive findings even at PSA < 5 ng/ml. Therefore, FCH PET/CT should not be restricted to patients with PSA > 5 ng/ml.

Key words

F-18-fluorocholine PET/CT Restaging of prostate cancer Prostate specific antigen (PSA) 

References

  1. 1.
    Roehl KA, Han M, Ramos CG, Antenor JA, Catalona WJ (2004) Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 172:910–914CrossRefPubMedGoogle Scholar
  2. 2.
    Kamat AM, Rosser CJ, Levy LB, et al. (2004) Rise in serum PSA of 1.5 ng/mL above 24-month nadir after external beam radiotherapy is predictive of biochemical failure. Urology 63:1132–1137CrossRefPubMedGoogle Scholar
  3. 3.
    Moul JW (2000) Prostate specific antigen only progression of prostate cancer. J Urol 163:1632–1642CrossRefPubMedGoogle Scholar
  4. 4.
    Huch Boni RA, Meyenberger C, Pok Lundquist J, Trinkler F, Lutolf U, Krestin GP (1996) Value of endorectal coil versus body coil MRI for diagnosis of recurrent pelvic malignancies. Abdom Imaging 21:345–352CrossRefPubMedGoogle Scholar
  5. 5.
    Leventis AK, Shariat SF, Slawin KM (2001) Local recurrence after radical prostatectomy: correlation of US features with prostatic fossa biopsy findings. Radiology 219:432–439PubMedGoogle Scholar
  6. 6.
    Roudier MP, Vesselle H, True LD, et al. (2003) Bone histology at autopsy and matched bone scintigraphy findings in patients with hormone refractory prostate cancer: the effect of bisphosphonate therapy on bone scintigraphy results. Clin Exp Metastasis 20:171–180CrossRefPubMedGoogle Scholar
  7. 7.
    Partin AW, Pearson JD, Landis PK, et al. (1994) Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases. Urology 43:649–659CrossRefPubMedGoogle Scholar
  8. 8.
    Okotie OT, Aronson WJ, Wieder JA, Liao Y, et al. (2004) Predictors of metastatic disease in men with biochemical failure following radical prostatectomy. J Urol 171:2260–2264CrossRefPubMedGoogle Scholar
  9. 9.
    de Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJ (2003) 11C-choline positron emission tomography for the evaluation after treatment of localized prostate cancer. Eur Urol 44:32–38PubMedCrossRefGoogle Scholar
  10. 10.
    Picchio M, Messa C, Landoni C, et al. (2003) Value of [11C]choline-positron emission tomography for re-staging prostate cancer: a comparison with [18F]fluorodeoxyglucose-positron emission tomography. J Urol 169:1337–1340CrossRefPubMedGoogle Scholar
  11. 11.
    DeGrado TR, Reiman RE, Price DT, Wang S, Coleman RE (2002) Pharmacokinetics and radiation dosimetry of 18F-fluorocholine. J Nucl Med 43:92–96PubMedGoogle Scholar
  12. 12.
    DeGrado TR, Coleman RE, Wang S, et al. (2001) Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res 61:110–117PubMedGoogle Scholar
  13. 13.
    DeGrado TR, Baldwin SW, Wang S, et al. (2001) Synthesis and evaluation of (18)F-labeled choline analogs as oncologic PET tracers. J Nucl Med 42:1805–1814PubMedGoogle Scholar
  14. 14.
    Price DT, Coleman RE, Liao RP, Robertson CN, Polascik TJ, DeGrado TR (2002) Comparison of [18 F]fluorocholine and [18 F]fluorodeoxyglucose for positron emission tomography of androgen dependent and androgen independent prostate cancer. J Urol 168:273–280CrossRefPubMedGoogle Scholar
  15. 15.
    Hara T, Kosaka N, Kishi H (2002) Development of (18)F-fluoroethylcholine for cancer imaging with PET: synthesis, biochemistry, and prostate cancer imaging. J Nucl Med 43:187–199PubMedGoogle Scholar
  16. 16.
    Vassiliev D, Krasikova R, Kutznetsova O, Federova O, Nader M (2003) Simple HPLC Method for the Detection of N,N-dimethylaminoethanol in the Preparation of [N-m ethyl-11C]Choline [abstract]. Eur J Nucl Med 30(suppl):342PGoogle Scholar
  17. 17.
    Delbeke D, Martin WH (2004) PET and PET-CT for evaluation of colorectal carcinoma. Semin Nucl Med 34:209–223CrossRefPubMedGoogle Scholar
  18. 18.
    Maldonado A, Sancho F, Cerdan J, et al. (2000) FDG-PET in the detection of recurrence in colorectal cancer based on rising CEA level. Experience in 72 patients. Clin Positron Imaging 3:170CrossRefPubMedGoogle Scholar
  19. 19.
    Helal BO, Merlet P, Toubert ME, et al. (2001) Clinical impact of (18)F-FDG PET in thyroid carcinoma patients with elevated thyroglobulin levels and negative (131)I scanning results after therapy. J Nucl Med 42:1464–1469PubMedGoogle Scholar
  20. 20.
    Hofer C, Laubenbacher C, Block T, Breul J, Hartung R, Schwaiger M (1999) Fluorine-18-fluorodeoxyglucose positron emission tomography is useless for the detection of local recurrence after radical prostatectomy. Eur Urol 36:31–35CrossRefPubMedGoogle Scholar
  21. 21.
    Macara IG (1989) Elevated phosphocholine concentration in ras-transformed NIH 3T3 cells arises from increased choline kinase activity, not from phosphatidylcholine breakdown. Mol Cell Biol 9:325–328PubMedGoogle Scholar
  22. 22.
    de Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJ (2003) Preoperative staging of pelvic lymph nodes in prostate cancer by 11C-choline PET. J Nucl Med 44:331–335PubMedGoogle Scholar
  23. 23.
    Kwee SA, Coel MN, Lim J, Ko JP (2005) Prostate cancer localization with 18fluorine fluorocholine positron emission tomography. J Urol 173:252–255PubMedCrossRefGoogle Scholar
  24. 24.
    Liu CS, Shen YY, Lin CC, Yen RF, Kao CH (2002) Clinical impact of [(18)F]FDG-PET in patients with suspected recurrent breast cancer based on asymptomatically elevated tumor marker serum levels: a preliminary report. Jpn J Clin Oncol 32:244–247CrossRefPubMedGoogle Scholar
  25. 25.
    Gomez P, Manoharan M, Kim SS, Soloway MS (2004) Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated? BJU Int 94:299–302CrossRefPubMedGoogle Scholar
  26. 26.
    Menzel C, Dobert N, Hamscho N, et al. (2004) The influence of CA 125 and CEA levels on the results of (18)F-deoxyglucose positron emission tomography in suspected recurrence of epithelial ovarian cancer. Strahlenther Onkol 180:497–501CrossRefPubMedGoogle Scholar
  27. 27.
    Chang TC, Law KS, Hong JH, et al. (2004) Positron emission tomography for unexplained elevation of serum squamous cell carcinoma antigen levels during follow-up for patients with cervical malignancies: a phase II study. Cancer 101:164–171CrossRefPubMedGoogle Scholar
  28. 28.
    Coleman R, DeGrado T, Wang S, et al. (2000) Preliminary evaluation of F-18 Fluorocholine (FCH) as a PET tumor imaging agent. Clin Positron Imaging 3:147CrossRefPubMedGoogle Scholar
  29. 29.
    Heinisch M, Meier S, Salomon U, Panholzer PJ, Stoiber P, Langsteger W (2004) Initial experience in F18-fluorocholine PET/CT in prostate cancer—implications for the determination of a PET/CT acquisition protocol. Q J Nucl Med Mol Imaging 48(suppl):7PGoogle Scholar

Copyright information

© Academy of Molecular Imaging 2005

Authors and Affiliations

  • Martin Heinisch
    • 1
  • Albert Dirisamer
    • 2
  • Wolfgang Loidl
    • 3
  • Franz Stoiber
    • 3
  • Bernhard Gruy
    • 1
  • Silke Haim
    • 1
  • Werner Langsteger
    • 1
  1. 1.Department of Nuclear Medicine, PET Center LinzSt. Vincent’s Hospital LinzLinzAustria
  2. 2.Department of RadiologyUniversity Hospital ViennaViennaAustria
  3. 3.Department of UrologySt. Vincent's Hospital LinzLinzAustria

Personalised recommendations