Three-phase 18F-fluorocholine PET/CT in the evaluation of prostate cancer recurrence.
OBJECTIVE
Contribution of 3-phase 18F-fluorocholine PET/CT in suspected prostate cancer recurrence at early rise of PSA.


METHODS
Retrospective analysis was performed in 47 patients after initial treatment with radiotherapy (n=30) or surgery (n=17). Following CT, 10 minutes list-mode PET acquisition was done over the prostate bed after injection of 300 MBq of 18F-fluorocholine. Three timeframes of 3 minutes each were reconstructed for analysis. All patients underwent subsequent whole body PET/CT. Delayed pelvic PET/CT was obtained in 36 patients. PET/CT was interpreted visually by two observers and SUVmax determined for suspicious lesions. Biopsies were obtained from 13 patients.


RESULTS
Biopsies confirmed the presence of cancer in 11 of 13 patients with positive PET for a total of 15 local recurrences in which average SUVmax increased during 14 minutes post injection and marginally decreased in delayed scanning. Conversely inguinal lymph nodes with mild to moderate metabolic activity on PET showed a clearly different pattern with decreasing SUVmax on dynamic images. Three-phase PET/CT contributed to the diagnostic assessment of 10 of 47 patients with biological evidence of recurrence of cancer. It notably allowed the discrimination of confounding blood pool or urinary activity from suspicious hyperactivities. PET/CT was positive in all patients with PSA>or=2 ng/ml (n=34) and in 4/13 patients presenting PSA values<2 ng/ml.


CONCLUSIONS
18F-fluorocholine 3-phase PET/CT showed a progressively increasing SUVmax in biopsy confirmed cancer lesions up to 14 minutes post injection while decreasing in inguinal lymph nodes interpreted as benign. Furthermore, it was very useful in differentiating local recurrences from confounding blood pool and urinary activity.
Steiner
Ch
Ch
Service of Nuclear Medicine, Hospital Care System Research and Analysis Group, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland. Franz.Buchegger@HCUGE.CH
Vees
H
H
Zaidi
H
H
Wissmeyer
M
M
Berrebi
O
O
Kossovsky
M P
MP
Khan
H G
HG
Miralbell
R
R
Ratib
O
O
Buchegger
F
F
D000368:Aged; D000369:Aged, 80 and over; D002794:Choline / Q000031:analogs & derivatives*; D005462:Fluorine Radioisotopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D005462:Fluorine Radioisotopes; C514960:fluorocholine; D017430:Prostate-Specific Antigen; D002794:Choline