n-n-dimethyl-n-(18f)fluoromethyl-2-hydroxyethylammonium and Adenocarcinoma

We assessed the value of fusion (18)F-fluoromethylcholine ((18)F-choline) PET/MRI for image-guided (targeted) prostate biopsies to detect significant prostate cancer (Gleason ≥ 3 + 4) compared with standard (systematic 12-core) biopsies.. Within an ongoing prospective clinical trial, hybrid (18)F-choline PET/CT and multiparametric 3T MRI (mpMRI) of the pelvis were performed in 36 subjects with a rising prostate-specific antigen for known (n = 15) or suspected (n = 21) prostate cancer before a prostate biopsy procedure. PET and T2-weighted MR volumes of the prostate were spatially registered using commercially available software. Biopsy targets were selected on the basis of visual appearance on MRI and graded as low, intermediate, or high risk for significant disease. Volumes of interest were defined for MR-identified lesions. (18)F-choline uptake measures were obtained from the MR target and a mirrored background volume of interest. The biopsy procedure was performed after registration of real-time transrectal ultrasound with T2-weighted MR and included image-guided cores plus standard cores. Histologic results were determined from standard and targeted biopsy cores as well as prostatectomy specimens (n = 10).. Fifteen subjects were ultimately identified with Gleason ≥ 3 + 4 prostate cancer, of which targeted biopsy identified significantly more (n = 12) than standard biopsies (n = 5; P = 0.002). A total of 52 lesions were identified by mpMRI (19 low, 18 intermediate, 15 high risk), and mpMRI-assigned risk was a strong predictor of final pathology (area under the curve = 0.81; P < 0.001). When the mean (18)F-choline target-to-background ratio was used, the addition of (18)F-choline to mpMRI significantly improved the prediction of Gleason ≥ 3 + 4 cancers over mpMRI alone (area under the curve = 0.92; P < 0.001).. Fusion PET/MRI transrectal ultrasound image registration for targeted prostate biopsies is clinically feasible and accurate. The addition of (18)F-choline PET to mpMRI improves the identification of significant prostate cancer.

Topics: Adenocarcinoma; Aged; Choline; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Male; Middle Aged; Molecular Imaging; Multimodal Imaging; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Ultrasonography

We report the case of a 69-year-old man referred for F-fluorocholine (FCH) PET/CT for a biochemical recurrence of prostate cancer. FCH PET/CT demonstrated 2 hypodense hepatic lesions with no uptake but progressing in size compared with a previous assessment. MRI showed a suspicious peripheral contrast enhancement, raising the question of a liver metastasis. Histopathologic examination concluded to a prostate adenocarcinoma metastasis. This case highlights an unusual pitfall in FCH PET/CT: the lack of uptake in prostatic liver metastasis is presumably due to the partial volume effect induced by the necrotic center and the high uptake of the liver.

Topics: Adenocarcinoma; Aged; Biological Transport; Choline; Humans; Liver Neoplasms; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

To date, bone metastases remain the main cause of morbidity and mortality in patients with metastatic castration-resistant prostate cancer (mCRPC). Therefore, the combination of accurate early detection of bony disease and effective treatment of these lesions is crucial in the management of mCRPC patients, but clinical trials specifically designed to test novel approaches are currently lacking.. This report describes the case of a 74-year-old male with bone mCRPC and symptomatic and biochemical progression, who underwent radium-223 therapy, following previous treatment failure. 18F-choline positron emission tomography (PET)/computed tomography (CT) was used to assess changes in skeletal tumor activity before and after radium-223. Changes in prostate-specific antigen and alkaline phosphatase were also determined. 18F-choline PET/CT showed that treatment with radium-223 was able to effectively reduce bone metastatic disease, and this was accompanied by an excellent metabolic response.. In clinical practice, metabolic assessment of lesions by 18F-choline PET/CT following radium-223 seems a valid approach to monitor treatment response. Until results from clinical trials become available, reporting of single cases relating to data on the use of this technique remains paramount.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Choline; Fluorine Radioisotopes; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms, Castration-Resistant; Radium

Topics: Adenocarcinoma; Choline; Humans; Male; Melanoma; Meningeal Carcinomatosis; Middle Aged; Neoplasms, Multiple Primary; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

Computed tomography and magnetic resonance imaging detected an isolated adrenal lesion in an elderly man with high-risk prostate cancer who was undergoing radiotherapy (RT) and hormonal therapy (HT). When prostate-specific antigen (PSA) was 31.66 ng/mL, the lesion was not identified as a metastasis by 18F-choline positron emission tomography/computed tomography (18F-choline-PET/CT). When PSA was over 100 ng/mL, 18F-choline-PET/CT diagnosed the malignancy. After adrenalectomy, PSA returned to normal, and stable disease remission was obtained. This case suggests that atypical metastasis may be underdiagnosed.

Topics: Adenocarcinoma; Adrenal Gland Neoplasms; Adrenalectomy; Aged; Antineoplastic Agents, Hormonal; Biomarkers, Tumor; Chemotherapy, Adjuvant; Choline; Fluorine Radioisotopes; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Multimodal Imaging; Neoplasms, Second Primary; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiotherapy, Adjuvant; Tomography, X-Ray Computed

We report the results of whole body 18F-fluorocholine (FCH) PET/CT in a single patient with biochemical suspicion of prostate adenocarcinoma relapse and recent history of minor head injury. PET showed an intense area of increased FCH uptake in the right parietal bone, without any morphological abnormality on either CT or skull radiographs. Understanding the radiotracer's physiological biodistribution as well as the nonmalignant etiologies of FCH uptake are essential requirements for a correct diagnostic interpretation of FCH PET/CT in patients with biological recurrence of prostate cancer.

Topics: Adenocarcinoma; Choline; Diagnostic Errors; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Skull; Tomography, X-Ray Computed