title: New Clinical Indications for (18)F/(11)C-choline, New Tracers for Positron Emission Tomography and a Promising Hybrid Device for Prostate Cancer Staging: A Systematic Review of the Literature.
abstract: Radiolabelled choline positron emission tomography has changed the management of prostate cancer patients. However, new emerging radiopharmaceutical agents, like radiolabelled prostate specific membrane antigen, and new promising hybrid imaging will begin new challenges in the diagnostic field.
  
  
  
  The continuous evolution in nuclear medicine has led to the improvement in the detection of recurrent prostate cancer (PCa), particularly distant metastases. New horizons have been opened for radiolabelled choline positron emission tomography (PET)/computed tomography (CT) as a guide for salvage therapy or for the assessment of systemic therapies. In addition, new tracers and imaging tools have been recently tested, providing important information for the management of PCa patients. Herein we discuss: (1) the available evidence in literature on radiolabelled choline PET and their recent indications, (2) the role of alternative radiopharmaceutical agents, and (3) the advantages of a recent hybrid imaging device (PET/magnetic resonance imaging) in PCa.
  
  
  
  Data from recently published (2010-2015), original articles concerning the role of choline PET/CT, new emerging radiotracers, and a new imaging device are analysed. This review is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
  
  
  
  In the restaging phase, the detection rate of choline PET varies between 4% and 97%, mainly depending on the site of recurrence and prostate-specific antigen levels. Both 68gallium (68Ga)-prostate specific membrane antigen and 18F-fluciclovine are shown to be more accurate in the detection of recurrent disease as compared with radiolabelled choline PET/CT. Particularly, Ga68-PSMA has a detection rate of 50% and 68%, respectively for prostate-specific antigen levels < 0.5ng/ml and 0.5-2ng/ml. Moreover, 68Ga- PSMA PET/magnetic resonance imaging demonstrated a particularly higher accuracy in detecting PCa than PET/CT. New tracers, such as radiolabelled bombesin or urokinase-type plasminogen activator receptor, are promising, but few data in clinical practice are available today.
  
  
  
  Some limitations emerge from the published papers, both for radiolabelled choline PET/CT and also for new radiopharmaceutical agents. Efforts are still needed to enhance the impact of published data in the world of oncology, in particular when new radiopharmaceuticals are introduced into the clinical arena.
  
  
  
  In the present review, the authors summarise the last evidences in clinical practice for the assessment of prostate cancer, by using nuclear medicine modalities, like positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging.
authors: Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy. Electronic address: laura.evangelista@ioveneto.it.
authors: Laura
authors: L
authors: Evangelista
authors: Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
authors: Alberto
authors: A
authors: Briganti
authors: Service of Nuclear Medicine, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
authors: Stefano
authors: S
authors: Fanti
authors: Department of Urology, University Hospital, Leuven, Belgium.
authors: Stephen
authors: S
authors: Joniau
authors: Klinik für Nuklearmedizin, Universität Ulm, Ulm, Germany.
authors: Sven
authors: S
authors: Reske
authors: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Italy.
authors: Riccardo
authors: R
authors: Schiavina
authors: Department of Urology, Ludwig-Maximilians-Universität Munich, Germany.
authors: Christian
authors: C
authors: Stief
authors: Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
authors: George N
authors: GN
authors: Thalmann
authors: Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Maria
authors: M
authors: Picchio
mesh_terms: D000954:Antigens, Surface; D002250:Carbon Radioisotopes; D002264:Carboxylic Acids; D002794:Choline / Q000031:analogs & derivatives*; D003503:Cyclobutanes; D005710:Gallium Radioisotopes; D043425:Glutamate Carboxypeptidase II; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging / Q000295:instrumentation; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D019275:Radiopharmaceuticals; D011880:Radiotherapy Planning, Computer-Assisted; D016879:Salvage Therapy
chemical_list: D000954:Antigens, Surface; D002250:Carbon Radioisotopes; D002264:Carboxylic Acids; D003503:Cyclobutanes; D005710:Gallium Radioisotopes; D019275:Radiopharmaceuticals; C117460:fluciclovine F-18; C514960:fluorocholine; C473848:FOLH1 protein, human; D043425:Glutamate Carboxypeptidase II; D002794:Choline
keywords: Disease management; Prostate cancer; Radiopharmaceuticals; Recurrences; Therapies