[18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients.
OBJECTIVE
We evaluated the potential of PET/CT and [(18)F]fluoromethylcholine (FCH) in the assessment of suspected recurrence of prostate cancer after treatment.


METHODS
One hundred consecutive prostate cancer patients with a persistent increase in serum PSA (>0.1 ng/ml) after radical prostatectomy (58 cases), radiotherapy (21 cases) or hormonal therapy alone (21 cases) were investigated. After injection of 3.7-4.07 MBq/kg of FCH, both early (at <15 min) and delayed (at >60 min) PET/CT scans were performed in 43 patients, delayed PET/CT scans in 53 patients and early PET/CT scans in four patients.


RESULTS
Of the 100 patients, 54 (PSA 0.22-511.79 ng/ml) showed positive FCH PET/CT scans. Thirty-seven patients had bone and/or abdominal lymph node uptake, while 17 showed pelvic activity. Malignant disease was confirmed in all but one. Delayed SUV(max) of bone metastases was significantly higher (p<0.0001 by paired t test) than that measured at <15 min, whereas no differences were observed between early and delayed SUVs of malignant lymph nodes or pelvic disease. Forty-six patients (PSA 0.12-14.3 ng/ml) showed negative FCH PET/CT scans. Of the negative PET/CT scans, 89% were obtained in patients with serum PSA <4 ng/ml and 87% in patients with a Gleason score <8. In none of these cases could recurrent tumour be proven clinically during a follow-up of 6 months.


CONCLUSIONS
FCH PET/CT is not likely to have a significant impact on the care of prostate cancer patients with biochemical recurrence until PSA increases to above 4 ng/ml. However, in selected patients, FCH PET/CT helps to exclude distant metastases when salvage local treatment is intended.
Cimitan
Marino
M
Department of Nuclear Medicine, National Cancer Institute-CRO Aviano (IRCCS), Aviano (PN), Italy. mcimitan@cro.it
Bortolus
Roberto
R
Morassut
Sandro
S
Canzonieri
Vincenzo
V
Garbeglio
Antonio
A
Baresic
Tanja
T
Borsatti
Eugenio
E
Drigo
Annalisa
A
Trovò
Mauro G
MG
D000368:Aged; D000369:Aged, 80 and over; D002454:Cell Differentiation; D049109:Cell Proliferation; D002794:Choline / Q000031:analogs & derivatives* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D012008:Recurrence; D013997:Time Factors; D014057:Tomography, X-Ray Computed
C514960:fluorocholine; D017430:Prostate-Specific Antigen; D002794:Choline