title: 11C-choline PET/CT identifies osteoblastic and osteolytic lesions in patients with metastatic prostate cancer.
abstract: OBJECTIVE
  The aim of this study was to compare C-choline PET/CT, prostate-specific antigen (PSA), PSA kinetics, and C-choline uptake in recurrent metastatic prostate cancer patients with osteoblastic and osteolytic bone metastases.
  
  
  METHODS
  We retrospectively analyzed 140 patients with the following criteria: (a) positive bone lesions identified with C-choline PET/CT and validated as true positive by histology (14.2%), correlative imaging (33.4%), or clinical follow-up (52.4%); (b) after radical prostatectomy (67.9%) or primary radiotherapy (22.1%); (c) proven biochemical relapse with rising PSA levels; (d) no chemotherapy, zoledronic acid, or palliative bone external beam radiation therapy previously administrated during biochemical relapse; and (f) asymptomatic for bone pain. Lesions were categorized as osteoblastic, osteolytic, or bone marrow lesions. Patients were divided into osteoblastic and osteolytic patient groups.
  
  
  RESULTS
  C-Choline PET/CT detected oligometastatic bone disease (1-3 lesions) in 98 (70%) of the 140 patients and multiple bone lesions in 42 (30%) of the 140 patients. By per-lesion analysis of 304 lesions, there were 184 osteoblastic, 99 osteolytic, and 21 bone marrow lesions.By per-patient analysis, 97 (69.3%) of the 140 patients were in the osteoblastic group, whereas 43 (30.7%) of the 140 patients were in the osteolytic group. Statistically significant differences in SUVmax (P < 0.001), fast PSA doubling time (P = 0.01), and PSA velocity (P = 0.01) were observed between osteoblastic (lower values) and osteolytic (higher values) groups. By multivariate analysis, fast PSA doubling time was a significant predictor for osteolytic lesions.
  
  
  CONCLUSIONS
  We demonstrated differences in PSA kinetics and SUVmax between osteolytic and osteoblastic lesions. C-Choline PET/CT may identify patients that could benefit from early targeted therapies, depending on the type of bone lesions expressed.
authors.affiliation: From the *Service of Nuclear Medicine, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna Italy; †Department of Nuclear Medicine, Medizinische Universität Innsbruck, Innsbruck, Austria; ‡Department of Urology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna; §Department of Nuclear Medicine and PET/CT Center, Santa Maria della Misericordia Hospital, Rovigo, Italy; and ║Department of Radiology, University of Southern California, LAC + USC Medical Center, Los Angeles, CA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ceci
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellucci
authors.forename: Tiziano
authors.initials: T
authors.lastname: Graziani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Sotirios
authors.initials: S
authors.lastname: Chondrogiannis
authors.forename: Rachele
authors.initials: R
authors.lastname: Bonfiglioli
authors.forename: Stefano
authors.initials: S
authors.lastname: Costa
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Virgolini
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Colletti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D002250:Carbon Radioisotopes; D002794:Choline; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline