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18F-Fluoromethylcholine (FCH) PET imaging in patients with castration-resistant prostate cancer: prospective comparison with standard imaging

European Journal of Nuclear Medicine and Molecular Imaging volume 38, pages 14–22 (2011)Cite this article

Abstract

Purpose

The aim of the study was to assess the utility of 18F-fluorocholine (FCH), compared to standard imaging of bone scan (BS) and contrast-enhanced abdominopelvic computed tomography (CT), in patients with castration-resistant prostate carcinoma.

Methods

FCH has shown promise as a metabolic imaging agent for prostate carcinoma. Twenty-six patients with castration-resistant prostate carcinoma had FCH, BS and CT imaging within a 2-month period. Individual FCH-positive lesions in bone were compared to the BS and soft tissue lesions were compared to CT. The lesions were then classified as concordant or discordant for the presence or absence of prostate cancer metastases. Discordant bone or soft tissue lesions were followed up with BS or CT, respectively, at 6-month intervals for up to 2 years or until a definitive diagnosis of the discordant lesion could be made.

Results

In 13 (50%) of the patients, all lesions identified were concordant; this included 5 patients in whom no lesions could be identified with any imaging modality. In 21 patients, 183 lesions were observed with 149 being concordant and 34 (19%) being discordant (13 patients). Based on follow-up, FCH correctly identified the presence or absence of disease in 27 of 34 lesions, and in 14 cases FCH-positive lesions, not identified on initial imaging, were confirmed as disease on follow-up. The sensitivity, specificity, accuracy, positive predictive and negative predictive values for lesion detection by FCH are 96% (92–98%), 96% (81–99%), 96% (93–97%), 99% (96–100%) and 81% (64–88%), respectively, with 95% confidence intervals shown in parentheses.

Conclusion

In this patient cohort, FCH shows good initial concordance (81%) with BS and CT in the detection of metastatic prostate carcinoma. Follow-up of the cases where FCH was initially discordant with subsequent BS or CT shows that FCH was accurate in determining the presence or absence of prostate metastasis in 79% of lesions. While FCH imaging as compared to BS and CT in this patient group has a good sensitivity and specificity for the detection of lesions representing prostate metastasis, further prospective studies are needed to determine its role.

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Acknowledgments

We would like to thank the Royal Perth Hospital Medical Research Foundation for the generous grant to allow completion of this trial.

Declarations

All human studies have been approved by the appropriate Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.

Conflicts of interest

None.

Author information

Affiliations

  1. Department of Nuclear Medicine, Royal Perth Hospital, Perth, WA, Australia

    Michael McCarthy, Teck Siew & Andrew Campbell

  2. WA PET Service, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Michael McCarthy, Teck Siew & Nat Lenzo

  3. Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, WA, Australia

    Andrew Campbell

  4. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Nigel Spry

  5. Faculty of Medicine and Pharmacology, School of Medicine, University of Western Australia, Perth, Australia

    Nigel Spry

  6. School of Surgery, UWA, Royal Perth Hospital, Perth, Australia

    Justin Vivian

  7. Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Laurence Morandeau

Authors
  1. Michael McCarthy
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  2. Teck Siew
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  3. Andrew Campbell
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  4. Nat Lenzo
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  5. Nigel Spry
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  6. Justin Vivian
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  7. Laurence Morandeau
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Correspondence to Michael McCarthy.

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McCarthy, M., Siew, T., Campbell, A. et al. 18F-Fluoromethylcholine (FCH) PET imaging in patients with castration-resistant prostate cancer: prospective comparison with standard imaging. Eur J Nucl Med Mol Imaging 38, 14–22 (2011). https://doi.org/10.1007/s00259-010-1579-x

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  • DOI: https://doi.org/10.1007/s00259-010-1579-x

Keywords

  • FCH
  • Fluoromethylcholine
  • PET
  • Castration-resistant prostate cancer
  • CT
  • Bone scan