Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Molecular Imaging and Biology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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 172:910–914

    Article  PubMed  Google Scholar 

  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 63:1132–1137

    Article  PubMed  Google Scholar 

  3. Moul JW (2000) Prostate specific antigen only progression of prostate cancer. J Urol 163:1632–1642

    Article  PubMed  CAS  Google Scholar 

  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 21:345–352

    Article  PubMed  CAS  Google Scholar 

  5. Leventis AK, Shariat SF, Slawin KM (2001) Local recurrence after radical prostatectomy: correlation of US features with prostatic fossa biopsy findings. Radiology 219:432–439

    PubMed  CAS  Google Scholar 

  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 20:171–180

    Article  PubMed  CAS  Google Scholar 

  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 43:649–659

    Article  PubMed  CAS  Google Scholar 

  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 171:2260–2264

    Article  PubMed  Google Scholar 

  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 44:32–38

    Article  PubMed  Google Scholar 

  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 169:1337–1340

    Article  PubMed  CAS  Google Scholar 

  11. DeGrado TR, Reiman RE, Price DT, Wang S, Coleman RE (2002) Pharmacokinetics and radiation dosimetry of 18F-fluorocholine. J Nucl Med 43:92–96

    PubMed  CAS  Google Scholar 

  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 61:110–117

    PubMed  CAS  Google Scholar 

  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 42:1805–1814

    PubMed  CAS  Google Scholar 

  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 168:273–280

    Article  PubMed  Google Scholar 

  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 43:187–199

    PubMed  CAS  Google Scholar 

  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):342P

    Google Scholar 

  17. Delbeke D, Martin WH (2004) PET and PET-CT for evaluation of colorectal carcinoma. Semin Nucl Med 34:209–223

    Article  PubMed  Google Scholar 

  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 3:170

    Article  PubMed  Google Scholar 

  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 42:1464–1469

    PubMed  CAS  Google Scholar 

  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 36:31–35

    Article  PubMed  CAS  Google Scholar 

  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 9:325–328

    PubMed  CAS  Google Scholar 

  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 44:331–335

    PubMed  Google Scholar 

  23. Kwee SA, Coel MN, Lim J, Ko JP (2005) Prostate cancer localization with 18fluorine fluorocholine positron emission tomography. J Urol 173:252–255

    Article  PubMed  Google Scholar 

  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 32:244–247

    Article  PubMed  Google Scholar 

  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 94:299–302

    Article  PubMed  Google Scholar 

  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 180:497–501

    Article  PubMed  Google Scholar 

  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 101:164–171

    Article  PubMed  Google Scholar 

  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 3:147

    Article  PubMed  Google Scholar 

  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):7P

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, PET Center Linz, St. Vincent’s Hospital Linz, Seilerstaette 4, A-4010, Linz, Austria

    Martin Heinisch MD, Bernhard Gruy, Silke Haim & Werner Langsteger

  2. Department of Radiology, University Hospital Vienna, Vienna, Austria

    Albert Dirisamer

  3. Department of Urology, St. Vincent's Hospital Linz, Linz, Austria

    Wolfgang Loidl & Franz Stoiber

Authors
  1. Martin Heinisch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Albert Dirisamer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolfgang Loidl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franz Stoiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernhard Gruy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Silke Haim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Werner Langsteger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Heinisch MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heinisch, M., Dirisamer, A., Loidl, W. 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 8, 43–48 (2006). https://doi.org/10.1007/s11307-005-0023-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11307-005-0023-2

Key words

Search

Navigation