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Choline PET/CT for imaging prostate cancer: an update

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Abstract

Whole-body positron emission tomography/computed tomography (PET/CT) with [11C]- and [18F]-labeled choline derivates has emerged as a promising molecular imaging modality for the evaluation of prostate cancer. 11C- and 18F-choline PET/CT are used successfully for restaging prostate cancer in patients with biochemical recurrence of disease after definitive therapy, especially when the serum prostate-specific antigen level is >1.0 ng/mL. 11C- and 18F-choline PET/CT have more limited roles for the initial staging of prostate cancer and for the detection of tiny lymph node metastases due to the low spatial resolution inherent to PET. Overall, these modalities are most useful in patients with a high pre-test suspicion of metastatic disease. The following is a review of the current clinical roles of 11C- and 18F-choline PET/CT in the management of prostate cancer.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.

    Article  PubMed  Google Scholar 

  2. Eberhardt SC, Carter S, Casalino DD, Merrick G, Frank SJ, Gottschalk AR, et al. ACR appropriateness criteria prostate cancer—pretreatment detection, staging, and surveillance. J Am Coll Radiol. 2013;10:83–92.

    Article  PubMed  Google Scholar 

  3. Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 2010;28:1117–23.

    Article  PubMed  Google Scholar 

  4. Hara T, Kosaka N, Kishi H. PET imaging of prostate cancer using carbon-11-choline. J Nucl Med. 1998;39:990–5.

    PubMed  CAS  Google Scholar 

  5. Hara T, Kosaka N, Kishi H. Development of (18)F-fluoroethylcholine for cancer imaging with PET: synthesis, biochemistry, and prostate cancer imaging. J Nucl Med. 2002;43:187–99.

    PubMed  CAS  Google Scholar 

  6. Ackerstaff E, Glunde K, Bhujwalla ZM. Choline phospholipid metabolism: a target in cancer cells? J Cell Biochem. 2003;90:525–33.

    Article  PubMed  CAS  Google Scholar 

  7. Farsad M, Schiavina R, Castelluci P, Nanni C, Corti B, Martorana G, et al. Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis. J Nucl Med. 2005;46:1642–9.

    PubMed  CAS  Google Scholar 

  8. Yamaguchi T, Lee J, Uemura H, Sasaki T, Takahashi N, Oka T, et al. Prostate cancer: a comparative study of 11C-choline PET and MR imaging combined with proton MR spectroscopy. Eur J Nucl Med Mol Imaging. 2005;32:742–8.

    Article  PubMed  CAS  Google Scholar 

  9. Martorana G, Sciavina R, Corti B, Farsad M, Salizzoni E, Brunocilla E, et al. 11C-choline positron emission tomography/computerized tomography for tumor localization of primary prostate cancer in comparison with 12-core biopsy. J Urol. 2006;176:954–60.

    Article  PubMed  CAS  Google Scholar 

  10. Reske SN, Blumstein NM, Neumaier B, Gottfried HW, Finsterbusch F, Kocot D, et al. Imaging prostate cancer with 11C-choline PET/CT. J Nucl Med. 2006;47:1249–54.

    PubMed  CAS  Google Scholar 

  11. Scher B, Seitz M, Albinger W, Tiling R, Scherr M, Becker HC, et al. Value of 11C-choline PET and PET/CT in patients with suspected prostate cancer. Eur J Nucl Med Mol Imaging. 2007;34:45–53.

    Article  PubMed  Google Scholar 

  12. Testa C, Schiavina R, Lodi R, Salizzoni E, Corti B, Farsad M, et al. Prostate cancer: sextant localization with MR imaging, MR spectroscopy, and 11C-choline PET/CT. Radiology. 2007;244:797–806.

    Article  PubMed  Google Scholar 

  13. Giovacchini G, Picchio M, Coradeschi E, Scattoni V, Bettinardi V, Cozzarini C, et al. [(11)C]choline uptake with PET/CT for the initial diagnosis of prostate cancer: relation to PSA levels, tumor stage and anti-androgenic therapy. Eur J Nucl Med Mol Imaging. 2008;35:1065–73.

    Article  PubMed  CAS  Google Scholar 

  14. Watanabe H, Kanematsu M, Kondo H, Kako N, Yamamoto N, Yamada T, et al. Preoperative detection op prostate cancer: a comparison with 11C-choline PET, 18F-fluorodeoxyglucose PET and MR imaging. J Magn Reson Imaging. 2010;31:1151–6.

    Article  PubMed  Google Scholar 

  15. Van den Bergh L, Koole M, Isebaert S, Joniau S, Deroose CM, Oyen R, et al. Is there an additional value of 11C-choline PET/CT to T2-weighted MRI images in the localization of intraprostatic tumor nodules? Int J Radiat Oncol Biol Phys. 2012;83:1486–92.

    Article  PubMed  Google Scholar 

  16. Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48:932–45.

    Article  PubMed  Google Scholar 

  17. Murphy RC, Kawashima A, Peller PJ. The utility of 11C-choline PET/CT for imaging prostate cancer: a pictorial guide. AJR. 2011;196:1390–8.

    Article  PubMed  Google Scholar 

  18. Piert M, Park H, Khan A, Siddiqui J, Hussain H, Chenevert T, et al. Detection of aggressive primary prostate cancer with 11C-choline PET/CT using multimodality fusion techniques. J Nucl Med. 2009;50:1585–93.

    Article  PubMed  CAS  Google Scholar 

  19. Souvatzoglou M, Weirich G, Schwarzenboeck S, Maurer T, Schster T, Bundschuh RA, et al. The sensitivity of [11C]choline PET/CT to localize prostate cancer depends on the tumor configuration. Clin Cancer Res. 2011;17:3751–9.

    Article  PubMed  Google Scholar 

  20. Kwee SA, Coel MN, Lim J, Ko JP. Prostate cancer localization with 18 fluorine fluorocholine positron emission tomography. J Urol. 2005;173:252–5.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. Kwee SA, Thibault GP, Stack RS, Coel MN, Furusato B, Sesterhenn IA. Use of step-section histopathology to evaluate 18F-fluorocholine PET sextant localization of prostate cancer. Mol Imaging. 2008;7:12–20.

    PubMed  Google Scholar 

  23. Igerc I, Kohlfurst S, Gallowitsch HJ, Matschnig S, Kresnik E, Gomez-Segovial I, et al. The value of 18F-choline PET/CT in patients with elevated PSA-level and negative prostate needle biopsy for localization of prostate cancer. Eur J Nucl Med Mol Imaging. 2008;35:976–83.

    Article  PubMed  CAS  Google Scholar 

  24. Beheshti M, Imamovic L, Broinger G, Vali R, Waldenberger P, Stoiber F, et al. 18F choline PET/CT in the preoperative staging of prostate cancer in patients with intermediate or high risk of extracapsular disease: a prospective study of 130 patients. Radiology. 2010;254:925–33.

    Article  PubMed  Google Scholar 

  25. Castelluci 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.

    Article  Google Scholar 

  26. Reske SN, Blumstein NM, Glatting G. [11C]choline PET/CT imaging in occult local relapse of prostate cancer after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2008;35:9–17.

    Article  PubMed  Google Scholar 

  27. Panebianco V, Sciarra A, Lisi D, Galati F, Buonocore V, Catalano C, et al. Prostate cancer: 1HMRS-DCEMR at 3T versus [(18)F]choline PET/CT in the selection of local prostate cancer recurrence in men with biochemical progression after radical retropubic prostatectomy (RRP). Eur J Radiol. 2012;81:700–8.

    Article  PubMed  Google Scholar 

  28. Vees H, Buchegger F, Albrecht S, Khan H, Husarik D, Zaidi H, et al. 18F-choline and/or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low prostate-specific antigen values (<1 ng/mL) after radical prostatectomy. BJU Int. 2007;99:1415–20.

    Article  PubMed  CAS  Google Scholar 

  29. Schiavina R, Scattoni V, Castelluci P, Picchio M, Corti B, Briganti A, et al. 11C-choline positron emission tomography/computed tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: comparison with clinical staging nomograms. Eur Urol. 2008;54:392–401.

    Article  PubMed  Google Scholar 

  30. Contractor K, Challapali A, Barwick T, Winkler M, Hellawell G, Hazell S, et al. Use of [11C]choline PET-CT as a noninvasive method for detecting pelvic lymph node status from prostate cancer and relationship with choline kinase expression. Clin Cancer Res. 2011;17:7673–83.

    Article  PubMed  CAS  Google Scholar 

  31. Budiharto T, Joniau S, Lerut E, van den Bergh L, Mottaghy F, Deroose CM, et al. Prospective evaluation of 11C-choline positron emission tomography/computed tomography and diffusion-weighted magnetic resonance imaging for the nodal staging of prostate cancer with a high risk of lymph node metastases. Eur Urol. 2011;60:125–30.

    Article  PubMed  Google Scholar 

  32. Hacker A, Jeschke S, Leeb K, Prammer K, Ziegerhofer J, Sega W, et al. Detection of pelvic lymph node metastases in patients with clinically localized prostate cancer: comparison of [18F]fluorocholine positron emission tomography-computed tomography and laparoscopic guided sentinel lymph node dissection. J Urol. 2006;176:2014–8.

    Article  PubMed  Google Scholar 

  33. Steuber T, Schlomm T, Heinzer H, Zacharias M, Ahyai S, Chun KF, et al. [F(18)]-fluoroethylcholine combined in-line PET-CT scan for detection of lymph-node metastasis in high risk prostate cancer patients prior to radical prostatectomy: preliminary results from a prospective histology-based study. Eur J Cancer. 2010;46:449–55.

    Article  PubMed  CAS  Google Scholar 

  34. Poulsen MH, Bouchelouche K, Hoilund-Carlsen PF, Petersen H, Gerke O, Steffansen SI, et al. [18F]-fluorocholine positron-emission/computed tomography for lymph node staging of prostate cancer: a prospective study of 210 patients. BJU Int. 2012;110:1666–71.

    Article  PubMed  CAS  Google Scholar 

  35. Scattoni V, Picchio M, Suardi N, Messa C, Freschi M, Roscigno M, et al. Detection of lymph-node metastases with integrated [11C]choline PET/CT in patients with PSA failure after radical retropubic prostatectomy; results confirmed by open pelvic-retroperitoneal lymphadenectomy. Eur Urol. 2007;52:423–9.

    Article  PubMed  Google Scholar 

  36. Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008;63:387–95.

    Article  PubMed  CAS  Google Scholar 

  37. Harisinghani MG, Barentsz J, Hahn PF, Deserno WM, Tabatabaei S, van de Kaa CH, et al. Noninvasive detection of locally lymph node metastases in prostate cancer. N Engl J Med. 2003;348:2491–9.

    Article  PubMed  Google Scholar 

  38. Picchio M, Spinapolice EG, Fallanca F, Crivellaro C, Giovacchini G, Gianolli L, et al. [11C]choline PET/CT detection of bone metastases in patients with PSA progression after primary treatment for prostate cancer: comparison with bone scintigraphy. Eur J Nucl Med Mol Imaging. 2012;39:13–26.

    Article  PubMed  CAS  Google Scholar 

  39. Fuccio C, Castellucci P, Schiavina R, Santi I, Allegri V, Pettinato V, et al. Role of 11C-choline PET/CT in the restaging of prostate cancer patients showing a single lesion on bone scintigraphy. Ann Nucl Med. 2010;24:485–92.

    Article  PubMed  CAS  Google Scholar 

  40. Beheshti M, Vali R, Waldenberger P, Fitz F, Nader M, Hammer J, et al. The use of F-18 choline PET in the assessment of bone metastases in prostate cancer: correlation with morphological changes on CT. Mol Imaging Biol. 2009;11:446–54.

    Article  PubMed  Google Scholar 

  41. Rinnab L, Mottaghy FM, Blumstein NM, Reske SN, Hautmann RE, Hohl K, et al. Evaluation of [11C]-choline positron-emission/computed tomography in patients with increasing prostate-specific antigen levels after primary treatment for prostate cancer. BJU Int. 2007;100:786–93.

    Article  PubMed  CAS  Google Scholar 

  42. 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.

    Article  PubMed  CAS  Google Scholar 

  43. Rinnab L, Simon J, Hautmann RE, Cronauer MV, Hohl K, Buck AK, et al. [11C]choline PET/CT in prostate cancer patients with biochemical recurrence after radical prostatectomy. World J Urol. 2009;27:619–25.

    Article  PubMed  CAS  Google Scholar 

  44. 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.

    Article  PubMed  Google Scholar 

  45. Richter JA, Rodriguez M, Rioja J, Penuelas I, Marti-Climent J, Garrastachu P, et al. Dual tracer 11C-choline and FDG-PET in the diagnosis of biochemical prostate cancer relapse after radical treatment. Mol Imaging Biol. 2009;12:210–7.

    Article  PubMed  Google Scholar 

  46. Giovacchini G, Picchio M, Coradeschi E, Bettinardi V, Gianolli L, Scattoni V, et al. Predictive factors of [11C]choline PET/CT in patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2010;37:301–9.

    Article  PubMed  Google Scholar 

  47. Breeuwsma AJ, Prium J, van den Bergh AC, Leliveld AM, Nijman RJ, Dierckx RA, et al. Detection of local, regional, and distant recurrence in patients with PSA relapse after external-beam radiotherapy using 11C-choline positron emission tomography. Int J Radiat Oncol Biol Phys. 2010;77:160–4.

    Article  PubMed  Google Scholar 

  48. 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.

    Article  PubMed  Google Scholar 

  49. Cimitan M, Bortolus R, Morassut S, Canzonieri V, Garbeglio A, Barresic T, et al. [18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients. Eur J Nucl Med Mol Imaging. 2006;33:1387–98.

    Article  PubMed  Google Scholar 

  50. 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.

    Article  PubMed  Google Scholar 

  51. Schillaci O, Calabria F, Tavolozza M, Caracciolo CR, Finazzi Agro E, Miano R, et al. Influence of PSA, PSA velocity and PSA doubling time on contrast-enhanced 18F-choline PET/CT detection rate in patients with rising PSA after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2012;39:589–96.

    Article  PubMed  CAS  Google Scholar 

  52. Kwee SA, Coel MN, Lim J. Detection of recurrent prostate cancer with 18F-fluorocholine PET/CT in relation to PSA level at the time of imaging. Ann Nucl Med. 2012;26:501–7.

    Article  PubMed  CAS  Google Scholar 

  53. Pelosi E, Arena V, Skanjeti A, Pirro V, Couroukas A, Pupi A, et al. Role of whole-body 18F-choline PET/CT in disease detection in patients with biochemical relapse after radical treatment for prostate cancer. Radiol Med. 2008;113:895–904.

    Article  PubMed  CAS  Google Scholar 

  54. Graute V, Jansen N, Ubleis C, Seitz M, Hartenbach M, Scherr MK, et al. Relationship between PSA kinetics and [18F]fluorocholine PET/CT detection rates of recurrence in patients with prostate cancer after total prostatectomy. Eur J Nucl Med Mol Imaging. 2012;39:271–82.

    Article  PubMed  CAS  Google Scholar 

  55. Ceci F, Castellucci P, Mamede M, Schiavina R, Rubello D, Fuccio C, et al. 11C-choline PET/CT in patients with hormone-resistant prostate cancer showing biochemical relapse after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2013;40:149–55.

    Article  PubMed  CAS  Google Scholar 

  56. Kwee SA, Coel MN, Ly BH, Lim J. 18F-choline PET/CT imaging of RECIST measurable lesions in hormone refractory prostate cancer. Ann Nucl Med. 2009;23:541–8.

    Article  PubMed  CAS  Google Scholar 

  57. Soyka JD, Muster MA, Schmid DT, Seifert B, Schick U, Miralbell R, et al. Clinical impact of 18F-choline PET/CT in patients with recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2012;39:936–43.

    Article  PubMed  CAS  Google Scholar 

  58. 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.

    Article  PubMed  Google Scholar 

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Correspondence to Kazuhiro Kitajima.

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Kitajima, K., Murphy, R.C. & Nathan, M.A. Choline PET/CT for imaging prostate cancer: an update. Ann Nucl Med 27, 581–591 (2013). https://doi.org/10.1007/s12149-013-0731-7

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