Operational Characteristics of ¹¹ C-Choline Positron Emission Tomography/Computerized Tomography for Prostate Cancer with Biochemical Recurrence After Initial Treatment

Abstract

(11)C-choline positron emission tomography/computerized tomography performs well in men with biochemical recurrence after primary treatment failure. The optimal prostate specific antigen value for lesion detection is approximately 2.0 ng/ml. We found that (11)C-choline positron emission tomography/computerized tomography substantially enhances the rate of prostate cancer lesion detection by approximately 32% beyond what can be garnered using conventional imaging techniques and at a lower prostate specific antigen value.

11C- or 18F-Choline PET/CT for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer

“…Interestingly, only PSAdt and the ongoing hormonal treatment were statistically significant in the prediction of positive PET/CT scan results in a multivariate analysis (22). Mitchell et al evaluated the performance of 11 C-choline PET/CT in 176 patients with BR after treatment and found sensitivity, specificity, PPV, and NPV of 93%, 76%, 91%, and 81%, respectively (23). Moreover, the optimal PSA level for lesion detection was shown to be 2.0 ng/mL, and a multivariate analysis demonstrated that PSA (hazard ratio, 1.37; P 5 0.04) and clinical stage at initial diagnosis (hazard ratio, 5.19; P 5 0.0035) were significant predictors of positive 11 C-choline PET/CT scan results (23).…”

“…Mitchell et al evaluated the performance of 11 C-choline PET/CT in 176 patients with BR after treatment and found sensitivity, specificity, PPV, and NPV of 93%, 76%, 91%, and 81%, respectively (23). Moreover, the optimal PSA level for lesion detection was shown to be 2.0 ng/mL, and a multivariate analysis demonstrated that PSA (hazard ratio, 1.37; P 5 0.04) and clinical stage at initial diagnosis (hazard ratio, 5.19; P 5 0.0035) were significant predictors of positive 11 C-choline PET/CT scan results (23). In a recent metaanalysis, Fanti et al reported a 11 Ccholine PET/CT rate of detection of PCa at any site of relapse of 62% (95% confidence interval, 53%-71%), a pooled sensitivity of 89% (95% confidence interval, 83%-93%), and a pooled specificity of 87% (95% confidence interval, 71%-95%); these results were similar to previously reported results (24).…”

Radiopharmaceuticals as probes to characterize tumour tissue

“…Currently 11 C-choline PET is approved for the diagnosis of recurrent prostate cancer in patients who have raised prostatespecific antigen (PSA) following treatment and when anatomical imaging fails to provide evidence [189,190]. Although the majority of choline PET studies have shown significant correlation with PSA and tumour grade, the use of 11 C-choline is associated with a high incidence of false-negative findings which renders it unsuitable for routine use in initial detection of prostate cancer and makes histological confirmation always necessary [189,191].…”

Emerging treatments for recurrent prostate cancer

“…PET-CT using 11C-choline, a tracer which targets components of the phospholipids in the prostate cell membrane, has shown better results [8] [9] and novel PET radiotracers such as those that target prostate-specific membrane antigen (PSMA) are being investigated in the hope that these will show greater sensitivity and specificity for the detection of prostate cancer recurrences. [10,11] [12] Sodium fluoride F-18 imaging has also shown promising results, specifically for the identification of bone metastases.…”