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Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript



To investigate the clinical value of 18F-fluorocholine PET/CT (CH-PET/CT) in treatment decisions in patients with recurrent prostate cancer (rPCA).


The study was a retrospective evaluation of 156 patients with rPCA and CH-PET/CT for restaging. Questionnaires for each examination were sent to the referring physicians 14–64 months after examination. Questions included information regarding initial extent of disease, curative first-line treatment, and the treatment plan before and after CH-PET/CT. Additionally, PSA values at diagnosis, after initial treatment, before CH-PET/CT and at the end of follow-up were also obtained from the questionnaires.


Mean follow-up was 42 months. The mean Gleason score was 6.9 at initial diagnosis. Initial treatment was: radical prostatectomy in 110 patients, radiotherapy in 39, and combined prostatectomy and radiotherapy in 7. Median PSA values before CH-PET/CT and at the end of follow-up were 3.40 ng/ml and 0.91 ng/ml. PSA levels remained stable, decreased or were below measurable levels in 108 patients. PSA levels increased in 48 patients. In 75 of the 156 patients (48%) the treatment plan was changed due to the CH-PET/CT findings. In 33 patients the therapeutic plan was changed from palliative treatment to treatment with curative intent. In 15 patients treatment was changed from curative to palliative. In 8 patients treatment was changed from curative to another strategy and in 2 patients from one palliative strategy to another. In 17 patients the treatment plan was adapted.


CH-PET/CT has an important impact on the therapeutic strategy in patients with rPCA and can help to determine an appropriate treatment.

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  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90. doi:10.3322/caac.20107.

    Article  PubMed  Google Scholar 

  2. Lu-Yao GL, Potosky AL, Albertsen PC, Wasson JH, Barry MJ, Wennberg JE. Follow-up prostate cancer treatments after radical prostatectomy: a population-based study. J Natl Cancer Inst. 1996;88:166–73.

    Article  PubMed  CAS  Google Scholar 

  3. Bott SR. Management of recurrent disease after radical prostatectomy. Prostate Cancer Prostatic Dis. 2004;7:211–6. doi:10.1038/sj.pcan.45007324500732.

    Article  PubMed  CAS  Google Scholar 

  4. Fowler Jr FJ, Barry MJ, Lu-Yao G, Roman A, Wasson J, Wennberg JE. Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988-1990 (updated June 1993). Urology. 1993;42:622–9.

    Article  PubMed  Google Scholar 

  5. 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. doi:10.1001/jama.294.4.433.

    Article  PubMed  CAS  Google Scholar 

  6. 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. doi:10.1016/j.eururo.2011.01.025.

    Article  PubMed  Google Scholar 

  7. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol. 2011;59:61–71. doi:10.1016/j.eururo.2010.10.039.

    Article  PubMed  Google Scholar 

  8. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology, prostate cancer. 2010. Fort Washington: National Comprehensive Cancer Network

  9. Schmid DT, John H, Zweifel R, Cservenyak T, Westera G, Goerres GW, et al. Fluorocholine PET/CT in patients with prostate cancer: initial experience. Radiology. 2005;235:623–8. doi:10.1148/radiol.2352040494.

    Article  PubMed  Google Scholar 

  10. Picchio M, Briganti A, Fanti S, Heidenreich A, Krause BJ, Messa C, et al. The role of choline 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. doi:10.1016/j.eururo.2010.09.004.

    Article  PubMed  Google Scholar 

  11. Fanti S, Krause B, Weber W, Castellucci P, Grosu AL, de Jong IJ, et al. Re: Nicolas Mottet, Joaquim Bellmunt, Michel Bolla, et al. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2011;59:572-83. Eur Urol. 2011;60:e37–8; author reply e39–41. doi:10.1016/j.eururo.2011.08.009

    Article  PubMed  Google Scholar 

  12. 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. doi:10.2967/jnumed.108.061507.

    Article  PubMed  Google Scholar 

  13. Krause BJ, Souvatzoglou M, Tuncel M, Herrmann K, Buck AK, Praus C, et al. The detection rate of [11C]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. doi:10.1007/s00259-007-0581-4.

    Article  PubMed  CAS  Google Scholar 

  14. Husarik DB, Miralbell R, Dubs M, John H, Giger OT, Gelet A, et al. Evaluation of [(18)F]-choline PET/CT for staging and restaging of prostate cancer. Eur J Nucl Med Mol Imaging. 2008;35:253–63. doi:10.1007/s00259-007-0552-9.

    Article  PubMed  Google Scholar 

  15. Heinisch M, Dirisamer A, Loidl W, Stoiber F, Gruy B, Haim S, et al. Positron emission tomography/computed tomography with F-18-fluorocholine for restaging of prostate cancer patients: meaningful at PSA <5 ng/ml? Mol Imaging Biol. 2006;8:43–8. doi:10.1007/s11307-005-0023-2.

    Article  PubMed  Google Scholar 

  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. doi:10.1007/s00259-010-1604-0.

    Article  PubMed  Google Scholar 

  17. Souvatzoglou M, Krause BJ, Purschel A, Thamm R, Schuster T, Buck AK, et al. Influence of (11)C-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. doi:10.1016/j.radonc.2011.05.005.

    Article  PubMed  Google Scholar 

  18. Wurschmidt F, 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. doi:10.1186/1748-717X-6-44.

    Article  PubMed  Google Scholar 

  19. Rigatti P, Suardi N, Briganti A, Da Pozzo LF, Tutolo M, Villa L, 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;60:935–43. doi:10.1016/j.eururo.2011.07.060.

    Article  PubMed  Google Scholar 

  20. Kwee SA, Wei H, Sesterhenn I, Yun D, Coel MN. Localization of primary prostate cancer with dual-phase 18F-fluorocholine PET. J Nucl Med. 2006;47:262–9.

    PubMed  Google Scholar 

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Correspondence to Jan D. Soyka.

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Soyka, J.D., Muster, M.A., Schmid, D.T. et al. Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer. Eur J Nucl Med Mol Imaging 39, 936–943 (2012).

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