Change of management by using hybrid imaging with radiolabelled choline in biochemical recurrent prostate cancer: a systematic review and a meta-analysis



Hybrid imaging with radiolabelled choline has been extensively used in patients with biochemical recurrent prostate cancer (BRPCa). A useful information for the clinicians could be the change of management that can be obtained by using these imaging modalities in BRPCa. Therefore, we aimed to perform a systematic review and meta-analysis to add evidence-based data in this setting.


A comprehensive computer literature search of studies listed in PubMed/MEDLINE, EMBASE and Cochrane library databases through February 2020 and regarding the change of management by using hybrid imaging with radiolabelled choline in BRPCa was performed. A pooled analysis evaluating the percentage of change of management performing hybrid imaging with radiolabelled choline in BRPCa patients was carried out.


Nineteen studies on the change of management by using radiolabelled choline PET/CT or PET/MRI in 1931 BRPCa patients were included in the meta-analysis. Overall, a change of management by using radiolabelled choline PET/CT or PET/MRI was demonstrated in 45.8% (95% confidence interval 39.9–51.6%) of BRPCa patients. Significant heterogeneity among the selected studies was found, whereas a significant publication bias was excluded.


Our meta-analysis demonstrated that hybrid imaging with radiolabelled choline may change the management in about half of BRPCa patients. However, as for other PET radiopharmaceuticals, large-scale prospective multicentric studies are needed to investigate whether BRPCa patients can benefit from PET-related treatment changes.

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This study was performed with a grant received by the Advisory Board of Research of Ente Ospedaliero Cantonale (ABREOC).

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Correspondence to Giorgio Treglia.

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Ferrari, M., Renard, J., Pereira Mestre, R. et al. Change of management by using hybrid imaging with radiolabelled choline in biochemical recurrent prostate cancer: a systematic review and a meta-analysis. Clin Transl Imaging 9, 57–71 (2021).

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  • Prostate cancer
  • Management
  • PET
  • Choline
  • Multimodal imaging
  • Hybrid imaging
  • Meta-analysis