n-n-dimethyl-n-(18f)fluoromethyl-2-hydroxyethylammonium and Prostatic-Neoplasms

Localized very high-risk prostate cancer (VHR PCa) has long suffered from the inex-istence of good lymph node staging methods other than invasive surgery, as computed tomogra-phy has low sensitivity for nodal disease. With the rising use of positron emission tomography (PET), it is clinically meaningful to know its value for these patients. Our goal was to evaluate the real-life diagnostic accuracy of PET Choline in nodal staging, comparing it with the gold standard of extended pelvic lymph node dissection (ePLND).. We reviewed data from a high-volume center, including patients with VHR PCa according to current NCCN guidelines who underwent community 18F-fluorocholine PET/CT; followed by ro-botic assisted laparoscopic prostatectomy (RALP) and ePLND between 2010 and 2021.. We included 44 patients and 88 lymph node regions. Among those, 14/44 (31.8%) patients and 20/88 (22.7%) regions had nodal disease present on definitive pathology. In comparison with ePLND, we found a sensitivity of 64.3% (95% CI, 39.2-89.4%), specificity of 83.3% (95% CI, 70.0- 96.7%), PPV of 64.3% (95% CI, 39.2-89.4%), and NPV of 83.3% (95% CI, 70.0-96.7%) for nodal disease on a patient-based analysis; and sensitivity of 35.0% (95% CI, 14.1-60.0%), specificity of 88.2% (95% CI, 80.6-95.9%), PPV of 46.7% (95% CI, 21.4-71.9%), and NPV of 82.2% (95% CI, 73.4-91.0%) on a region-based analysis.. In our view 18F-fluorocholine PET/CT doesn't meet the criteria to be a standard exam for pre-operative staging for patients with VHR PCa, mostly due to its low sensitivity. However, other radiotracers should continue to be investigated in this setting.

Topics: Choline; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

PET/CT using prostate-specific membrane antigen (PSMA) and choline radiotracers is widely used for diagnosis of prostate cancer. However, the roles of and differences in diagnostic performance between these 2 radiotracers for prostate cancer are unclear. The aim of this study was to compare the staging and restaging performance of Ga-labeled PSMA and F-choline PET/CT imaging in prostate cancer.. A comprehensive search was performed in PubMed for studies reporting the staging performance of Ga-PSMA and F-choline PET/CT in prostate cancer from the inception of the database to October 1, 2018, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Thirty-five studies were included in this systematic review and meta-analysis. Pooled estimates of patient- and lesion-based sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) for Ga-PSMA and F-choline PET/CT were calculated alongside 95% confidence intervals. Summary receiver operating characteristic curves were plotted, and the area under the summary receiver operating characteristic curve (AUC) was determined alongside the Q* index.. The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of Ga-PSMA PET/CT for staging in prostate cancer (13 studies) were 0.92, 0.94, 7.91, 0.14, 79.04, and 0.96, respectively, whereas those of F-choline PET/CT (16 studies) were 0.93, 0.83, 4.98, 0.10, 68.27, and 0.95. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of Ga-PSMA PET/CT for staging in prostate cancer (9 studies) were 0.83, 0.95, 23.30, 0.17, 153.58, and 0.94, respectively, and those of F-choline PET/CT (4 studies) were 0.81, 0.92, 8.59, 0.20, 44.82, and 0.98. In both patient- and lesion-based imaging, there was no statistically significant difference in the abilities of detecting or excluding prostate cancer between Ga-PSMA PET/CT and F-choline PET/CT.. For staging and restaging performance in patients with prostate cancer, there was no significant difference between Ga-PSMA PET/CT and F-choline PET/CT. Ga-PSMA PET/CT and F-choline PET/CT have demonstrated high diagnostic performance for accurate staging and restaging in patients with prostate cancer, and thus both should be considered for staging in this disease.

Topics: Choline; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Oligopeptides; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results

The detection of neoplastic lymph nodal involvement in prostate cancer (PCa) patients has relevant therapeutic and prognostic significance, both in the clinical settings of primary staging and restaging. Lymph nodal dissection (LND) currently represents the gold standard for evaluating the presence of lymph nodal involvement. However, this procedure is invasive, associated with morbidity, and may fail in detecting all potential lymph nodal metastatic regions. Currently the criteria for lymph nodal detection using conventional imaging techniques mainly rely on morphological assessment with unsatisfactory diagnostic accuracy. Positron emission tomography (PET) represents a helpful imaging technique for a proper staging of lymph nodal status. The most investigated PET radiotracer is choline, although many others have been explored as guide for both primary and salvage LND, such as fluorodeoxyglucose, acetate, fluorocyclobutanecarboxylic acid and prostate-specific membrane antigen. In the present review, a comprehensive literature review addressing the role of PET for LND in PCa patients is reported, with the use of the above-mentioned radiotracers.

Topics: Acetates; Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Edetic Acid; Fluorodeoxyglucose F18; Gallium Isotopes; Gallium Radioisotopes; Humans; Lymph Node Excision; Lymph Nodes; Magnetic Resonance Imaging; Male; Multimodal Imaging; Neoplasm Staging; Oligopeptides; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals

Recurrence of prostate cancer is suspected when an increase in the prostate-specific antigen level is detected after radical treatment; the recurrence could be local relapse, distant relapse, or both. Differentiation between the two patterns of relapse is critical for choosing the proper treatment strategy. Choline PET/CT could be of help in discriminating patients with local, lymph node, and bone recurrences, thus having an impact on patient management.

Topics: Choline; Diagnosis, Differential; Evidence-Based Medicine; Humans; Image Enhancement; Male; Neoplasm Recurrence, Local; Outcome Assessment, Health Care; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Treatment Outcome

Diagnosis, localization of recurrence in the management of prostate cancer patients with increasing concentrations of tumor serum markers is crucial for treatment planning of the patients. The present review describes the role of prostate MRI and (18) Fcholine PET/computed tomography (CT) in tumor detection and extent, when there is a suspicion of residual or recurrent disease after treatment of prostate cancer.. A systematic review of the literature was performed by searching in the PUB MED/MEDLINE database searching for articles in French or English published between the last 12years.. In patient with a clinical suspicion of recurrence after treatment for prostate cancer, imaging can be used to distinguish between local recurrence and metastatic disease. (11)C-choline PET/CT and pelvic multiparametric MR imaging (mp MRI) are complementary in this indication. In this paper, the current status of imaging techniques used for the staging of patients with suspected locally recurrent or metastatic disease in patients treated for prostate cancer were reviewed.. Mp MRI of the prostate may be valuable imaging modality for the detection and localization of local recurrence. C-choline PET/CT offers an advantage in detecting metastatic disease to lymph node and bone.

Topics: Choline; Fluorine Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Multimodal Imaging; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

The present review was conceived for describing the differences in biodistribution and diagnostic performance of two types of (18)F-radiolabeled choline for positron emission tomography (PET) imaging in prostate cancer (PCa), such as fluoromethylcholine (FCH) and fluoroethylcholine (FEC).. A collection of published data about two radiopharmaceutical agents was made by using PubMed, Web of Knowledge databases and Trip Database, and then a critical revision was discussed.. FCH was injected in 338 and 1164 patients, while FEC was injected in 20 and 139 patients, respectively for basal staging and re-staging. The diagnostic performances of FCH and FEC for the detection of lymph node metastasis before the surgical approach are typically around 50% or less and between 0% and 39%, respectively. Conversely, both the tracers appear useful for the detection of recurrent PCa in case of increase in absolute PSA value or in case of high levels of PSA velocity and PSA doubling time (sensitivity ranged between 42.9% and 96% for FCH and between 62% and 85.7% for FEC).. In according with the available information, FCH appears to be a more appropriate radiocompound as compared to FEC, although more comparative data are mandatory. A well designed and prospective trial for the evaluation of biokinetic data and diagnostic performance of both radiopharmaceutical agents seems essential.. FCH seems to be an appropriate radiopharmaceutical agent as compared to FEC. Anyway both the radiocompounds are useful in the evaluation of recurrent disease in case of a serial increase in PSA value and their performance improves when a correct preparation and acquisition protocol is employed.

Topics: Choline; Diagnostic Imaging; Humans; Male; Prostatic Neoplasms; Tissue Distribution

(1) To evaluate a new acquisition protocol of (18)F-choline (FCH) PET/CT for prostate cancer patients (PC), (2) to review acquisition (18)F-choline PET/CT methodology, and (3) to propose a standardized acquisition protocol on FCH PET/CT in PC patients.. 100 consecutive PC patients (mean age 70.5 years, mean PSA 21.35 ng/mL) were prospectively evaluated. New protocol consisted of an early scan of the pelvis immediately after the injection of the tracer (1 bed position of 4 min) followed by a whole body scan at one 1 hour. Early and 1 hour images were compared for interfering activity and pathologic findings.. The overall detection rate of FCH PET/CT was 64%. The early static images of the pelvis showed absence of radioactive urine in ureters, bladder, or urethra which allowed a clean evaluation of the prostatic fossae. Uptake in the prostatic region was better visualized in the early phase in 26% (7/30) of cases. Other pelvic pathologic findings (bone and lymph nodes) were visualized in both early and late images.. Early (18)F-choline images improve visualization of abnormal uptake in prostate fossae. All pathologic pelvic deposits (prostate, lymph nodes, and bone) were visualized in both early and late images.

Topics: Adult; Aged; Aged, 80 and over; Choline; Humans; Lymph Nodes; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Recurrence; Reference Standards; Tomography, X-Ray Computed

Prostate cancer (PCA) is the second most common tumour in men worldwide. Whereas prostate specific antigen (PSA) is an established biochemical marker, the optimal imaging method for all clinical scenarios has not yet been found. With the rising number of PET centres there is an increasing availability and use of (18)F-/(11)C-choline or (11)C-acetate for staging of PCA. However, to date no final conclusion has been reached as to whether acetate or choline tracers should be preferred. In this review we provide an overview of the performance of choline and acetate PET for staging the primary and recurrent disease and lymph nodes in PCA, based on the literature of the last 10 years. Although predominantly choline has been used rather than acetate, both tracers performed in a similar manner in published studies. Choline as well as acetate have insufficient diagnostic accuracy for the staging of the primary tumour, due to a minimum detectable tumour size of 5 mm and inability to differentiate PCA from benign prostate hyperplasia, chronic prostatitis and high-grade intraepithelial neoplasia. Regarding lymph node staging, choline tracers have demonstrated a high specificity. Unfortunately, the sensitivity is only moderate. For staging recurrent disease, sensitivity depends on the level of serum PSA (PSA should be >2 ng/ml). This applies to both choline and acetate. However, despite these limitations, a significant number of patients with recurrent disease can benefit from PET imaging by a change in treatment planning.

Topics: Acetates; Carbon; Choline; Humans; Male; Multimodal Imaging; Neoplasm Staging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Recurrence; Sensitivity and Specificity; Tomography, X-Ray Computed

Determination of tumour involvement of regional lymph nodes in patients with prostate cancer (PCa) is of key importance for the proper planning of treatment.. To provide a critical overview of published reports and to perform a meta-analysis about the diagnostic performance of 18F-choline and 11C-choline positron emission tomography (PET) or PET/computed tomography (CT) in the lymph node staging of PCa.. A Medline, Web of Knowledge, and Google Scholar search was carried out to select English-language articles published before January 2012 that discussed the diagnostic performance of choline PET to individualise lymph node disease at initial staging in PCa patients. Articles were included only if absolute numbers of true-positive, true-negative, false-positive, and false-negative test results were available or derivable from the text and focused on lymph node metastases. Reviews, clinical reports, and editorial articles were excluded. All complete studies were reviewed; thus qualitative and quantitative analyses were performed.. From the year 2000 to January 2012, we found 18 complete articles that critically evaluated the role of choline PET and PCa at initial staging. The meta-analysis was carried out and consisted of 10 selected studies with a total of 441 patients. The meta-analysis provided the following results: pooled sensitivity 49.2% (95% confidence interval [CI], 39.9-58.4) and pooled specificity 95% (95% CI, 92-97.1). The area under the curve was 0.9446 (p<0.05). The heterogeneity ranged between 22.7% and 78.4%. The diagnostic odds ratio was 18.999 (95% CI, 7.109-50.773).. Choline PET and PET/CT provide low sensitivity in the detection of lymph node metastases prior to surgery in PCa patients. A high specificity has been reported from the overall studies. Studies carried out on a larger scale with a homogeneous patient population together with the evaluation of cost effectiveness are warranted.

Topics: Carbon Radioisotopes; Choline; Fluorine Radioisotopes; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

In prostate cancer, use of FDG, the radiopharmaceutical currently most widely used in oncology, is limited to the most aggressive cancers and, in the absence of another tracer, to attempting to localise occult recurrences detected biochemically (elevated PSA serum levels). Four other PET tracers are currently suggested in various situations of prostate cancer development: for guiding biopsies, for diagnosis and staging of the primary cancer and of local or metastatic recurrences, especially in bone, and for localizing occult biochemical recurrence. This article is illustrated by cases summarising our experience with fluoromethylcholine-(18F) and PET/CT. They cover a wide spectrum of clinical settings: localisation of intraprostatic neoplastic lesions, initial staging, monitoring treatment by ultrasound, detection of occult recurrences and characterisation of images on conventional imaging modalities, which are questionable or difficult to interpret.

Topics: Bone Neoplasms; Choline; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Male; Neoplasm Recurrence, Local; Neoplasm Staging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals

The bombesin derivative RM2 is a GRPr antagonist with strong binding affinity to prostate cancer (PCa). In this study, the impact of [. This phase I/II study was conducted in 30 biopsy-positive PCa subjects. The patients were stratified into high (10 patients), intermediate (10 patients), and low risk (10 patients) for extraglandular metastases as defined by National Comprehensive Cancer Network (NCCN) criteria (NCCN Clinical Practice Guidelines in Oncology, 2016). The prostate gland was classified in 12 anatomic segments for data analysis of the imaging modalities as well as histopathologic findings. The segment with the highest radiotracer uptake was defined as the "index lesion." All cases were scheduled to undergo prostatectomy with pelvic lymph node (LN) dissection in intermediate- and high-risk patients. Intraprostatic and pelvic nodal [. [

Topics: Bombesin; Choline; Gallium Radioisotopes; Humans; Male; Multiparametric Magnetic Resonance Imaging; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

This prospective, multicenter, open-label, randomized, crossover trial study was to evaluate the diagnostic performance of 18F-PSMA-1007 (PSMA) vs. 18F-Choline PET/CT (FCH) in prostate cancer (PCa) patients (pts) with biochemical recurrence (BCR).. One hundred eighty-six pts, who have undergone primary definitive treatment for PCa with BCR, were recruited to this prospective study. All pts underwent one PSMA and one FCH PET/CT examination in randomized order within a time frame of 8 days and were followed up for at least 6 months (182 ± 10 days).. Recurrence of PCa was observed in 176 out of 186 pts. The overall correct detection rate (DR) was 84% (95% CI 0.7967-0.8830) for PSMA and 69% (95% CI 0.6191-0.7489) for FCH, yielding a difference in proportion of 16% ( P  < 0.0001). PSMA had a sensitivity of 0.8464 and FCH 0.6857 with an odds ratio of 2.5259 ( P  < 0.0001), with statistically significant greater sensitivity of PSMA (ORs, 2.7877 and 2.1283 respectively) ( P  < 0.0001). PET/CT imaging led to a more accurate diagnosis in 166 (89.2%) pts, of which PSMA had contributed more than FCH in 91 (54.8%) of them. The DR for cutoff point PSA ≤ 1 ng/ml was higher for PSMA compared to FCH (61.8% vs. 39.5%). DR value of 51.6% for PSMA reached at PSA ≤ 0.3 ng/ml, while FCH reached that DR value with PSA ≤ 2.2 ng/ml.. 18F-PSMA-1007 is more efficacious than 18F-Choline for the identification metastatic lesions both in patient and in regional level analysis in PCa patients with BCR.

Topics: Choline; Gallium Radioisotopes; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms

Recurrence occurs in more than 50% of prostate cancer. To be effective, treatments require precise localization of tumor cells. [F]fluoromethylcholine ([18F]FCH) PET/computed tomography (CT) is currently used to restage disease in cases of biochemical relapse. To be used for therapy response as has been suggested, repeatability limits of PET derived indices need to be established.. The aim of our study was to prospectively assess the qualitative and quantitative reproducibility [18F]FCH PET/CT in prostate cancer.. Patients with histologically proven prostate cancer referred for initial staging or restaging were prospectively included. All patients underwent two [18F]FCH PET/CTs in the same conditions within a maximum of 3 weeks' time. We studied the repeatability of the visual report and the repeatability of SUVmax and its evolution over the acquisition time in lesions, liver and vascular background. Statistical analysis was performed using the Bland-Altman approach.. Twenty-one patients were included. Reporting repeatability was excellent with 97.8% of concordance. Mean repeatability of SUVmax considering all times and all lesions was 2.2% ± 20. Evolution of SUVmax was unpredictable, either increasing or decreasing over the acquisition time, both for lesions and for physiological activity.. Our study demonstrated that visual report of [18F]FCH PET/CT was very reproducible and that the repeatability limits of SUVmax was similar to those of other PET radiotracers. An SUVmax difference of more than 40% should be considered as representing a treatment response effect. Change of SUVmax during the acquisition time varied and should not be considered as an interpretation criterion.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Reproducibility of Results; Time Factors

Repeatable quantification is essential when using (18)F-fluoromethylcholine PET/CT to monitor treatment response in prostate cancer. It has been shown that SUV normalized to the area under the blood activity concentration curve (SUVAUC) provides a better correlation with full kinetic analysis than does standard SUV. However, the precision of SUVAUC is not known yet. The purpose of this study was to assess the repeatability of various semiquantitative (18)F-fluoromethylcholine parameters in prostate cancer.. Twelve patients (mean age ± SD, 64 ± 8 y) with metastasized prostate cancer underwent two sets of (18)F-fluoromethylcholine PET/CT scans, on consecutive days. Each set consisted of a 30-min dynamic PET/CT scan of the chest after intravenous administration of 200 MBq of (18)F-fluoromethylcholine, followed by a whole-body PET/CT scan at 40 min. The dynamic scan was used to derive the area under the blood activity concentration curve. Lesion uptake was derived from the whole-body scan using various types of volumes of interest: maximum, peak, and mean. Each of these parameters was normalized to injected activity per body weight, area under the blood activity concentration curve, and blood concentration itself at 40 min, resulting in several types of SUVs: SUV, SUVAUC, and SUVTBR The test-retest repeatability of these metrics, as well as metabolic tumor volume (MTV) and total uptake of choline in the lesion, were studied. The level of agreement between test-retest data and reliability was assessed using Bland-Altman plots, repeatability coefficients, and intraclass correlation coefficients (ICCs).. A total of 67 choline-avid metastases were identified: 44 bone lesions and 23 lymph node lesions. In the case of SUVmax, the repeatability coefficients for SUV, SUVAUC, and SUVTBR were 26% (ICC, 0.95), 31% (ICC, 0.95), and 46% (ICC, 0.89), respectively. Similar values were obtained for SUVpeak and SUVmean The repeatability of SUVAUC was comparable to that of SUVmax, SUVpeak, and SUVmean. Tissue type and tumor localization did not affect repeatability. An MTV of less than 4.2 cm(3) had larger variability than larger volumes (repeatability coefficient, 45% vs. 29%; P = 0.048). The repeatability coefficient did not significantly differ between lesions with SUVpeak above or below the median value of 8.3 (19% vs. 28%; P = 0.264).. The repeatability of SUVAUC was comparable to that of standard SUV. The repeatability coefficients of various semiquantitative (18)F-fluoromethylcholine parameters (SUV, MTV, and total uptake in the lesion) were approximately 35%. Larger differences are likely to represent treatment effects.

Topics: Aged; Choline; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Reproducibility of Results

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

Image quality (IQ) of PET in voluminous body regions can be limited, which impairs the assessment of small metastatic lesions. Time-of-flight (TOF) reconstruction algorithm may deliver an increase of spatial resolution. The purpose of this study was to evaluate the impact of TOF on IQ, lesion detection rate, lesion volume (V) and SUVmax in F choline PET/CT of prostate cancer patients with biochemical recurrence compared to standard PET/CT reconstruction (standard).. During a period of 9 months, 32 patients with prostate cancer (mean [SD] age, 71 [7.8] years) and biochemical recurrence were included in this prospective institutional review board-approved study. Each patient underwent a state-of-the-art 3-dimensional F choline PET/CT. A total of 76 lesions were assessed by 2 board-certified nuclear medicine physicians and a third-year resident. Lesion volume and SUVmax of local recurrence, lymph nodes, and organ metastases were compared between TOF and standard. Image quality and lesion demarcation were rated according to a 5-point Likert-type scale. Interobserver agreement was assessed.. Eight additional lesions were detected using TOF (SUVmax, 3.64 [0.95]; V, 0.58 cm [0.50]). Image quality was reduced (IQ standard, 1.28; TOF, 1.77; P < 0.01) in calculated TOF images, although quality of lesion demarcation was improved (lesion demarcation: standard, 1.66; TOF, 1.26; P < 0.01). SUVmax was significantly increased in TOF images (SUVmax standard, 6.9 [4.1]; TOF, 8.1 [4.1]; P < 0.01), whereas V did not show significant differences (V standard, 5.3 [10.4] cm; TOF, 5.4 [10.3] cm; P = 0.41). Interobserver agreement was good for combined ratings (1 + 2 and 3 + 4).. Application of TOF seems to be of additional value to detect small metastatic lesions in patients with prostate cancer and biochemical recurrence, which may have further clinical implications for secondary treatment.

Topics: Algorithms; Choline; Humans; Image Processing, Computer-Assisted; Male; Multimodal Imaging; Neoplasm Recurrence, Local; Observer Variation; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

We compared the accuracy of (18)F-Choline-PET/MRI with that of multiparametric MRI (mMRI), (18)F-Choline-PET/CT, (18)F-Fluoride-PET/CT, and contrast-enhanced CT (CeCT) in detecting relapse in patients with suspected relapse of prostate cancer (PC) after external beam radiotherapy (EBRT). We assessed the association between standard uptake value (SUV) and apparent diffusion coefficient (ADC).. We evaluated 21 patients with biochemical relapse after EBRT. Patients underwent (18)F-Choline-PET/contrast-enhanced (Ce)CT, (18)F-Fluoride-PET/CT, and mMRI. Imaging coregistration of PET and mMRI was performed.. (18)F-Choline-PET/MRI was positive in 18/21 patients, with a detection rate (DR) of 86%. DRs of (18)F-Choline-PET/CT, CeCT, and mMRI were 76%, 43%, and 81%, respectively. In terms of DR the only significant difference was between (18)F-Choline-PET/MRI and CeCT. On lesion-based analysis, the accuracy of (18)F-Choline-PET/MRI, (18)F-Choline-PET/CT, CeCT, and mMRI was 99%, 95%, 70%, and 85%, respectively. Accuracy, sensitivity, and NPV of (18)F-Choline-PET/MRI were significantly higher than those of both mMRI and CeCT. On whole-body assessment of bone metastases, the sensitivity of (18)F-Choline-PET/CT and (18)F-Fluoride-PET/CT was significantly higher than that of CeCT. Regarding local and lymph node relapse, we found a significant inverse correlation between ADC and SUV-max.. (18)F-Choline-PET/MRI is a promising technique in detecting PC relapse.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prospective Studies; Prostatic Neoplasms; Proton Therapy; Radiography

We evaluated the potential of (18)F-fluoromethyldimethyl-2-hydroxyethyl-ammonium (FCH) PET/CT in the detection of recurrent disease or distant metastases and correlated its diagnostic accuracy with prostate-specific antigen (PSA) levels in prostate cancer patients with biochemical evidence of recurrence. Furthermore, the influences of androgen deprivation therapy (ADT) and its duration on (18)F-FCH PET were assessed in this study.. This prospective study included 250 prostate cancer patients with PSA relapse who underwent (18)F-FCH PET/CT. At the time of (18)F-FCH PET/CT imaging, the mean PSA level was 46.9 ± 314.7 ng/mL and 55.2% (138/250) of patients were receiving ADT. Overall, ADT was performed on 67.2% (168/250) of patients after initial treatment. Imaging was performed on an integrated PET/CT system. Acquisition started 1 min after intravenous injection of (18)F-FCH (4.07 MBq/kg of body weight) with dynamic PET images in the pelvic region during 8 min (1 min/frame) followed by a static semi-whole-body acquisition. The final diagnosis of positive PET lesions was based on histopathology or a consensus of clinical findings, additional imaging, or follow-up imaging modalities.. (18)F-FCH PET/CT was able to correctly detect malignant lesions in 74% (185/250) of patients but was negative in 26% (65/250). In 28% of patients, only 1 lesion was detected (69/250); from these, 65.2% (45 patients) had a local recurrence, 18.8% (13 patients) a single lymph node, and 15.9% (11 patients) a solitary bone metastasis. The sensitivity of the (18)F-FCH PET was significantly higher (P = 0.001) in patients with ongoing ADT (85%; confidence interval, 80%-91%) than in patients without ADT (59.5%; confidence interval, 50%-69%). (18)F-FCH PET sensitivity was 77.5%, 80.7%, 85.2%, and 92.8% for the trigger PSA levels of more than 0.5, 1.0, 2.0, and 4.0 ng/mL, respectively. Scan sensitivity was 33% in patients with a trigger PSA level of less than 0.3 ng/mL and 77% in patients with a trigger PSA level of greater than 0.3 ng/mL, respectively (P = 0.001). Using a binary logistic regression analysis model, we showed trigger PSA and ADT to be the only significant predictors of positive PET findings.. (18)F-FCH PET/CT proved its potential as a noninvasive 1-stop diagnostic modality enabling us to correctly detect occult disease in 74% of patients and to differentiate localized from systemic disease. In patients with biochemical recurrence, it also guides to an optimal treatment approach after initial treatment. Trigger PSA and ADT are the 2 significant predictors of (18)F-FCH-positive PET lesions. ADT seems not to impair (18)F-FCH uptake in hormone-refractory prostate cancer patients.

Topics: Aged; Androgens; Choline; Humans; Kinetics; Male; Multimodal Imaging; Neoplasm Staging; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Quaternary Ammonium Compounds; Recurrence; Risk Assessment; Tomography, X-Ray Computed

This study compares proton magnetic resonancespectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined techniques at 3T magnet versus [(18)F]choline PET/computed tomography (CT) in the detection of local prostate cancer recurrence in patients with biochemical progression after radical retropubic prostatectomy (RRP).. 84 consecutive patients at high risk of local recurrence underwent combined 1HMRSI-DCEMR and 18-Fcholine- PET/CT. MR scan protocol included turbo spin echo (TSE) T2-weighted sequences in the axial, sagittal and coronal planes; three-dimensional (3D) chemical shift imaging (CSI) sequences with spectral/spatial pulses optimized for quantitative detection of choline and citrate; dynamic contrast enhanced gradient-echo (GRE) T1-weighted sequence. The population was divided into two groups. Group A included 28 patients with a lesion size ranging between 5.00mm and 7.2mm and PSA reduction following radiation therapy. Group B included 56 patients with a lesion size between 7.6mm and 19.4mm. Sensitivity, specificity, positive predictive value (PPV) and accuracy were evaluated and receiver operating characteristic (ROC) curves were performed.. In Group A combined 1H-MRSI and DCE-MRI showed a sensitivity of 92%, a specificity of 75% (PPV 96%) while PET-CT examination showed a sensitivity of 62% and a specificity of 50% (PPV 88%) in identifying local recurrence. The accuracy of MRI was 89% while PET-CT showed an accuracy of 60%. Areas under the ROC curve (AUC) values for MR and PET-CT were 0.833 and 0.562, respectively. In Group B combined 1H-MRSI and DCEMR showed a sensitivity of 94% and a specificity of 100% (PPV 100%) with accuracy of 94%. PET-CT had a sensitivity of 92% and a specificity of 33% (PPV 98%) with accuracy of 91%. The AUCs for MR and PET-CT values were 0.971 and 0.837, respectively.. The diagnostic accuracy of combined 1HMRSI-DCEMR was higher than PET/CT to identify local prostate cancer recurrence, mostly in patients with low biochemical progression after RRP (0.2-2ng/mL).

Topics: Aged; Choline; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Middle Aged; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prognosis; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Protons; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique; Tomography, X-Ray Computed; Treatment Outcome

The aim of the study was to assess the utility of (18)F-fluorocholine (FCH), compared to standard imaging of bone scan (BS) and contrast-enhanced abdominopelvic computed tomography (CT), in patients with castration-resistant prostate carcinoma.. FCH has shown promise as a metabolic imaging agent for prostate carcinoma. Twenty-six patients with castration-resistant prostate carcinoma had FCH, BS and CT imaging within a 2-month period. Individual FCH-positive lesions in bone were compared to the BS and soft tissue lesions were compared to CT. The lesions were then classified as concordant or discordant for the presence or absence of prostate cancer metastases. Discordant bone or soft tissue lesions were followed up with BS or CT, respectively, at 6-month intervals for up to 2 years or until a definitive diagnosis of the discordant lesion could be made.. In 13 (50%) of the patients, all lesions identified were concordant; this included 5 patients in whom no lesions could be identified with any imaging modality. In 21 patients, 183 lesions were observed with 149 being concordant and 34 (19%) being discordant (13 patients). Based on follow-up, FCH correctly identified the presence or absence of disease in 27 of 34 lesions, and in 14 cases FCH-positive lesions, not identified on initial imaging, were confirmed as disease on follow-up. The sensitivity, specificity, accuracy, positive predictive and negative predictive values for lesion detection by FCH are 96% (92-98%), 96% (81-99%), 96% (93-97%), 99% (96-100%) and 81% (64-88%), respectively, with 95% confidence intervals shown in parentheses.. In this patient cohort, FCH shows good initial concordance (81%) with BS and CT in the detection of metastatic prostate carcinoma. Follow-up of the cases where FCH was initially discordant with subsequent BS or CT shows that FCH was accurate in determining the presence or absence of prostate metastasis in 79% of lesions. While FCH imaging as compared to BS and CT in this patient group has a good sensitivity and specificity for the detection of lesions representing prostate metastasis, further prospective studies are needed to determine its role.

Topics: Aged; Aged, 80 and over; Choline; Follow-Up Studies; Humans; Male; Middle Aged; Orchiectomy; Positron-Emission Tomography; Prostatic Neoplasms; Sensitivity and Specificity; Tomography, X-Ray Computed; Whole Body Imaging

Apply measurability criteria based on the response evaluation criteria in solid tumors (RECIST) to lesions found on (18)F-choline positron emission tomography (PET)/computerized tomography (CT) in patients with hormone refractory prostate cancer.. Whole-body PET followed by CT or in-line PET/CT using 3.3-4 MBq/kg of (18)F-choline was performed prospectively on 30 patients with prostate cancer, castrate testosterone levels, and rising post-treatment prostate specific antigen (PSA) levels. Lesions demonstrating increased (18)F-choline uptake were classified as measurable or non-measureable based on RECIST.. Three patients were known previously to have RECIST measurable lesions, 10 patients had metastatic findings on radionuclide bone scan, and 17 patients had elevated serum PSA level as the only evidence of disease. Lesions demonstrating increased (18)F-choline uptake were found in 28 (93%) patients. Thirty-eight PET/CT lesions from 14 patients were measurable by RECIST. Lymph node maximum standardized uptake value (SUV(max)) correlated with lymph node diameter (Pearson r = 0.44, p < 0. 001). RECIST measurable lymph node SUV(max) was significantly higher than that of non-measurable nodes (8.1 vs. 3.7, p < 0.0001). Detection of skeletal, prostatic, or RECIST-compatible lesions was more likely with a PSA level greater than 4.0 ng/ml (Fisher exact p = 0.0005).. Lesions detected with (18)F-choline PET/CT are frequently measurable by RECIST at baseline. Therefore, it may be feasible to include comparisons to RECIST in evaluations of (18)F-choline as a therapeutic response marker for hormone refractory prostate cancer.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Case-Control Studies; Choline; Hormones; Humans; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

To assess the detection rate of 18F-choline PET/CT in non-metastatic hormone-sensitive prostate cancer (hsPCa) and non-metastatic castrate resistant prostate cancer (CRPCa), based on the criteria proposed in the phase III SPARTAN trial and with high Gleason Score (GS).. One hundred forty patients were included. Of these, 82 patients were affected by hsPCa, and 58 had a CRPCa. Overall, 18F-Choline PET/CT was positive in 99/140 (70.7%). It was positive in 55/82 (67.1%) hsPCa patients and in 44/58 (75.9%) CRPCa subjects, respectively. The site of recurrence at 18F-Choline PET/CT were: 16 (27.6%) and 20 (24.4%) in prostatic bed, 25 (43.1%) and 24 (29.3%) in loco-regional lymph nodes and in 27 (46.6%) and 28 (34.1%) in distant organs, respectively for CRPCa and hsPCa patients. The optimal cut-off values for PSA at the time of PET/CT for the prediction or recurrence were 0.5 vs. 2.5 ng/mL for all site of recurrence (AUC: 0.70 vs. 0.72), 0.48 vs. 3.4 ng/mL for prostatic bed (AUC: 0.60 vs. 0.59), 0.5 vs. 1.5 for loco-regional lymph nodes (AUC: 0.62 vs. 0.57) and 2.2 vs. 2.8 ng/mL for distant metastasis (AUC: 0.74 vs. 0.71), respectively in CRPCa and hsPCa (all P=NS). Sensitivities and specificities of 18F-Choline PET/CT for the identification of recurrence disease in all patient population, in hsPCa and CRPCa were 83.7% and 87.5%, 78.9% and 88.9%, 91.4% and 85.7%, respectively.. The rate of positive 18F-Choline PET/CT is similar in patients with a hsPCa and CRPCa, in case of low PSAdt and high GS. Therefore, non-metastatic PCa patients should be assessed by molecular imaging, in order to adapt the most appropriate therapeutic approach.

Topics: Choline; Hormones; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Tomography, X-Ray Computed

In a 54-year-old patient referred for 18F-fluorocholine (FCH) baseline PET/CT before chemotherapy for biopsy-proven liver metastases, FCH PET/CT demonstrated multiple hypodense hepatic lesions with no FCH uptake and 2 positive bone metastases. FCH PET/CT performed after 6 cycles of docetaxel demonstrated a near normalization of the physiological uptake in the area of the sterilized liver metastases, which was confirmed by a drop in prostate-specific antigen and a complete metabolic response in the bone metastases. The present case demonstrates a new pattern of response defined by a reverse phenomenon from photopenic to normal uptake in responding liver metastases.

Topics: Bone Neoplasms; Choline; Humans; Liver Neoplasms; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

Few clinical and preclinical articles reported the potential usefulness of 18F-choline PET/CT in several hematological proliferative diseases. We report and incidental finding of a superscan-like pattern in a patient affected by essential thrombocythemia (ET), performing 18F-choline PET/CT for a biochemical recurrence of prostate cancer. The mild elevation of PSA values and the negativity of subsequent 68Ga-PSMA-11 PET/CT allowed to correlate the diffuse skeletal uptake detected on 18F-choline PET/CT to the underlying hematologic disease, rather than to a prostate cancer relapse.

Topics: Choline; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Thrombocythemia, Essential; Tomography, X-Ray Computed

The median baseline prostate-specific antigen was 11 ng/mL, the Gleason score was > 7 for 54% of patients, and the clinical stage was T1/T2 for 89% and T3 for 9% of patients. The baseline clinical model achieved an area under the receiver operating characteristic curve (AUC) of 0.73. Performances improved when clinical data were combined with radiomic features, in particular for PG. Radiomics reinforces clinical parameters in predicting BCR in intermediate and high-risk PCa patients. These first data strongly encourage further investigations on the use of radiomic analysis to identify patients at risk of BCR.

Topics: Artificial Intelligence; Humans; Male; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies

To assess the diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL with respect to 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer (PCa).. Patients with recent diagnosis of intermediate-/high-risk PCa without androgen deprivation therapy and previous 18F-Fluorocholine-PET/CT (negative for extraprostatic disease or with oligometastatic disease) were referred to 18F-DCFPyL-PET/CT. Patients' disease characteristic as grade group, D'Amico risk category (intermediate/high), prostate-specific antigen (PSA) closest to PET/CTs and its kinetics were obtained. The overall detection rate (DR) and molecular imaging TNM (miTNM) stage according to the prostate cancer molecular imaging standardized evaluation (PROMISE) criteria were assessed for both radiotracers, and their concordance (Kappa coefficient) was analyzed. The diagnostic and therapeutic impact of 18F-DCFPyL with respect to 18F-Fluorocholine was evaluated.. Fifty-eight patients were analyzed (84.5% high-risk). 18F-Fluorocholine showed a higher DR than 18F-DCFPyL of prostate gland involvement (100% versus 93.1%) and pelvic node disease (37.9% versus 31%; k = 0.436, p = 0.001). On the other hand, 18F-DCFPyL-PET/CT showed a higher DR of metastatic disease than 18F-Fluorocholine-PET/CT, 9/58 patients (15.5%): 3 M1a, 5 M1b and 1 M1c) versus 5/58 (8.6%) patients: 1 M1a and 4 M1b), k = 0.426; p = 0.001. No significant association was found between clinical characteristics (grade group, risk category, PSA level and kinetic) and 18F-Fluorocholine or 18F-DCFPyL results. The results of 18F-DCFPyL-PET/CT modified the previously planned treatment compared to 18F-Fluorocholine-PET/CT in 13 patients (22.4%).. 18F-Fluorocholine and 18F-DCFPyL PET/CT showed a similar DR of prostate gland and lymph node involvement, although with moderate concordance for the latter. 18F-DCFPyL was superior to 18F-Fluorocholine in detecting regional and distant metastasis with a therapeutic impact in one of every five patients.

Topics: Androgen Antagonists; Humans; Male; Pilot Projects; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms

We present a case of carotid glomus paraganglioma incidentally detected using 18F-choline PET/CT in a 63-year-old man with prostate cancer. 18F-choline PET/CT scan demonstrated a small area of 18F-choline uptake (SUVmax, 2.3) in the right parapharyngeal space of the neck, later diagnosed as paraganglioma with low proliferation index. 18F-choline PET/CT may represent a valid alternative for studying paraganglioma when either 18F-DOPA or 68Ga-SSA are not available.

Topics: Choline; Humans; Male; Middle Aged; Paraganglioma; Paraganglioma, Extra-Adrenal; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

A 79-year-old man with a history of prostate adenocarcinoma treated with prostatectomy underwent 18F-FCH PET/CT for restaging purpose, which was negative for relapse but showed the presence of choline-positive lymph nodes in the left axilla. The patient underwent a COVID-19 vaccination in the left arm 6 days prior. Thus, PET/CT findings were considered as inflammatory lymph nodes. With the current drive of global COVID-19 immunization, this case underlines the importance of knowing vaccination history to interpret correctly the findings and to avoid false-positive reports.

Topics: Aged; Choline; COVID-19; COVID-19 Vaccines; Humans; Lymphadenopathy; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; SARS-CoV-2; Vaccination

An 80-year-old man with a history of prostate cancer, treated with radical prostatectomy and bilateral obturator nodal dissection, underwent an 18F-choline PET/CT because of biochemical recurrence. The scan revealed an intense focal uptake in the right testicle. A subsequent orchifunicumlectomy demonstrated the presence of a classic seminoma. At present, 18F-FDG PET/CT is useful for initial staging of testicular cancer and determining the viability of residual masses >3 cm after completion of treatment, especially in patients with seminoma.

Topics: Aged, 80 and over; Choline; Humans; Incidental Findings; Male; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Seminoma; Testicular Neoplasms

Positron emission tomography-computed tomography (PET-CT) with [. The study retrospectively examined 177 patients with intermediate or high-risk prostate cancer who had undergone staging with FCH PET-CT before ePLND. Images were obtained with either the conventional Philips Gemini PET-CT (n = 93) or the digital SiPM-based GE Discovery MI PET-CT (n = 84) and compared.. Images that were obtained using the Philips Gemini PET-CT system showed 19 patients (20%) with suspected lymph node metastases, whereas the GE Discovery MI PET-CT revealed 36 such patients (43%). The sensitivity, specificity, and positive and negative predictive values were 0.3, 0.84, 0.47, and 0.72 for the Philips Gemini, while they were 0.58, 0.62, 0.31, and 0.83 for the GE Discovery MI, respectively. The areas under the curves in a receiver operating characteristic curve analysis were similar between the two PET-CT systems (0.57 for Philips Gemini and 0.58 for GE Discovery MI, p = 0.89).. Marked differences in sensitivity and specificity were found for the different PET-CT systems, although the overall diagnostic performance was similar. These differences are probably due to differences in both hardware and software, including reconstruction algorithms, and should be considered when new technology is introduced.

Topics: Choline; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Retrospective Studies

Gallium-68 (Ga)-PSMA and F-Choline are two radionuclides that have already shown high potential for the detection of prostate cancer. The comparison between these two radionuclides has several advantages in radiation protection. The aim of this prospective study was to identify which of these two radionuclides can help in predicting the equivalent dose using the maximum standard uptake value (SUVmax) of normal organs, the kidneys. Two groups of 40 patients (total n = 80) who underwent PET/CT using Ga or F for diagnosis of prostate cancer between April 2018 and December 2018 at the American University of Beirut Medical Center were included. First, the dose rates were measured after 1 h of radionuclide uptake at 1 m distance with background of 0.015 μSv h. Then, SUVmax for kidneys were determined from images obtained with PET/CT 1 h after injection of both radionuclides. The ratios of the equivalent doses to the SUVmax for kidneys were compared for both Ga-PSMA and F-Choline. There is a positive moderate relationship between the SUVmax for kidneys and the Ga dose rate after 1 h of injection at 1 m distance from the abdomen (p-value = 0.023 < 0.05). This relationship is statistically significant. However, there is a very low negative relationship between the SUVmax kidney and F dose rate after 1 h of injection at 1 m distance from the abdomen (p-value = 0.93 > 0.05). This relationship is not statistically significant. This leads to the suggestion that we can predict the equivalent dose due to Ga by indicating the SUVmax from the PET/CT images.

Topics: Choline; Diagnostic Reference Levels; Fluorine Radioisotopes; Gallium Isotopes; Gallium Radioisotopes; Humans; Kidney; Ligands; Male; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostatic Neoplasms; Radiation Dosage; Radiation Protection; Radiopharmaceuticals; Therapeutic Equivalency

Androgen deprivation therapy (ADT) remains a key approach in the treatment of prostate cancer (PCa). However, PCa inevitably relapses and becomes ADT resistant. Besides androgens, there is evidence that thyroid hormone thyroxine (T4) and its active form 3,5,3'-triiodo-L-thyronine (T3) are involved in the progression of PCa. Epidemiologic evidences show a higher incidence of PCa in men with elevated thyroid hormone levels. The thyroid hormone binding protein μ-Crystallin (CRYM) mediates intracellular thyroid hormone action by sequestering T3 and blocks its binding to cognate receptors (TRα/TRβ) in target tissues. We show in our study that low CRYM expression levels in PCa patients are associated with early biochemical recurrence and poor prognosis. Moreover, we found a disease stage-specific expression of CRYM in PCa. CRYM counteracted thyroid and androgen signaling and blocked intracellular choline uptake. CRYM inversely correlated with [18F]fluoromethylcholine (FMC) levels in positron emission tomography/magnetic resonance imaging of PCa patients. Our data suggest CRYM as a novel antagonist of T3- and androgen-mediated signaling in PCa. The role of CRYM could therefore be an essential control mechanism for the prevention of aggressive PCa growth.

Topics: Cell Line, Tumor; Choline; Cohort Studies; Crystallins; Down-Regulation; Gene Expression Profiling; Gene Expression Regulation, Neoplastic; Humans; Male; Metabolomics; mu-Crystallins; Neoplasm Staging; PC-3 Cells; Positron Emission Tomography Computed Tomography; Prognosis; Prostatic Neoplasms; Receptors, Androgen; Receptors, Thyroid Hormone; Sequence Analysis, RNA; Signal Transduction; Tissue Array Analysis; Triiodothyronine

Seminal vesicles are paired secretory glands located posterior to the bladder in men that produce seminal fluid to maintain sperm. Seminal vesicle reflux into the prostatic ducts may be associated with prostatitis in older patients or may represent a very rare complication of transurethral prostate resection in patients with prostatic cancer. This condition is frequently accidentally diagnosed on excretory urography and/or retrograde urethrogram. Clinical presentation includes pain, fever, recurrent epididymitis-prostatitis, and post void dribbling.

Topics: Aged; Choline; Diagnosis, Differential; Humans; Male; Middle Aged; Neoplasm Invasiveness; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Prostatitis; Seminal Vesicles; Transurethral Resection of Prostate

The aim of this study was (1) to investigate the application of texture analysis of choline PET/CT images in prostate cancer (PCa) patients and (2) to propose a machine-learning radiomics model able to select PET features predictive of disease progression in PCa patients with a same high-risk class at restaging.. Ninety-four high-risk PCa patients who underwent restaging Cho-PET/CT were analyzed. Follow-up data were recorded for a minimum of 13 months after the PET/CT scan. PET images were imported in LIFEx toolbox to extract 51 features from each lesion. A statistical system based on correlation matrix and point-biserial-correlation coefficient has been implemented for features reduction and selection, while Discriminant analysis (DA) was used as a method for features classification in a whole sample and sub-groups for primary tumor or local relapse (T), nodal disease (N), and metastatic disease (M).. In the whole group, 2 feature (HISTO_Entropy_log10; HISTO_Energy_Uniformity) results were able to discriminate the occurrence of disease progression at follow-up, obtaining the best performance in DA classification (sensitivity 47.1%, specificity 76.5%, positive predictive value (PPV) 46.7%, and accuracy 67.6%). In the sub-group analysis, the best performance in DA classification for T was obtained by selecting 3 features (SUVmin; SHAPE_Sphericity; GLCM_Correlation) with a sensitivity of 91.6%, specificity 84.1%, PPV 79.1%, and accuracy 87%; for N by selecting 2 features (HISTO = _Energy Uniformity; GLZLM_SZLGE) with a sensitivity of 68.1%, specificity 91.4%, PPV 83%, and accuracy 82.6%; and for M by selecting 2 features (HISTO_Entropy_log10 - HISTO_Entropy_log2) with a sensitivity 64.4%, specificity 74.6%, PPV 40.6%, and accuracy 72.5%.. This machine learning model demonstrated to be feasible and useful to select Cho-PET features for T, N, and M with valuable association with high-risk PCa patients' outcomes.. • Artificial intelligence applications are feasible and useful to select Cho-PET features. • Our model demonstrated the presence of specific features for T, N, and M with valuable association with high-risk PCa patients' outcomes. • Further prospective studies are necessary to confirm our results and to develop the application of artificial intelligence in PET imaging of PCa.

Topics: Artificial Intelligence; Choline; Humans; Machine Learning; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostatic Neoplasms

We present a case of a 68-year-old woman undergoing 18F-choline PET/CT due to a history of hepatocellular cancer treated with multimodal therapies and with a rapid increase in α-fetoprotein. 18F-Choline PET/CT showed multiple uptakes in the skeletal muscles compatible with the recurrence of disease. The interpretation of 18F-choline PET/CT in this cancer should be careful and discussed in a multidisciplinary team.

Topics: Aged; Carcinoma, Hepatocellular; Choline; Humans; Liver Neoplasms; Male; Muscle, Skeletal; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals

The aims of the study were (i) to examine the PCa detection rate of 18F-choline (FCH) PET/MRI and (ii) to assess the impact of PET/MRI findings in patients with PCa who develop OMD using PSA response as a biomarker.. We retrospectively analyzed a cohort of 103 patients undergoing FCH PET/MRI for biochemical recurrence of PCa. The inclusion criteria were (1) previous radical prostatectomy (RP) with or without adjuvant radiotherapy (RT); (2) PSA levels available at the time of PET; (3) OMD, defined as a maximum of 5 lesions on PET/MRI; and (4) follow-up data available for at least 6 months after PET. All images were reviewed by two nuclear medicine physicians and interpreted with the support of two radiologists.. Seventy patients were eligible for the study: 52 patients had a positive FCH PET/MRI and 18 had a negative scan. The overall PCa detection rates for MRI, PET, and PET/MRI were 65.7%, 37.1%, and 74.3%, respectively. Thirty-five patients were treated with radiotherapy (RT), 16 received hormonal therapy (HT), 3 had a combined therapy (RT + HT), and 16 (23%) underwent PSA surveillance. At follow-up, PSA levels decreased in 51 patients (73%), most of whom had been treated with RT or RT + HT. Therapeutic management was guided by PET/MRI in 74% of patients, which performed better than MRI alone (68% of patients).. FCH PET/MRI has a higher detection rate than MRI or PET alone for PCa patients with OMD and PSA levels > 0.5 ng/mL, prompting a better choice of treatment.

Topics: Choline; Humans; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Retrospective Studies

The aim of this study is to assess the value of the F-choline PET/computed tomography (CT) in predicting significant prostate cancer (sPCa) in patients with persistently increased prostate-specific antigen (PSA) levels and previous negative biopsies. To study the possible predictive added value of F-choline PET/CT to clinical variables and biomarkers derived from PSA in detecting sPCa.. We evaluated patients who underwent F-choline PET/CT because of ongoing suspicion of prostate cancer (PCa) due to elevated PSA levels (4-20 ng/mL) and at least one previous negative or no conclusive prostate biopsy for PCa. Age, PSA, free PSA, free/total PSA ratio, PSA velocity, PSA doubling time, PSA density and score risk were obtained. F-choline PET/CT was classified as negative/positive (PET-categorical). Additionally, we subclassified F-choline PET/CT according to the radiotracer uptake patterns (PET-pattern). The reference standard was the histological confirmation. Accuracy of PET/CT was evaluated. Univariate and multivariate logistic regression analyses were performed for metabolic and clinical variables.. A total of 78 patients were included in our study, 23 had PCa (15 with sPCa). The PET pattern showed the highest accuracy and was the most powerful predictor of sPCa. In this research, the prediction of sPCa was improved combining PET pattern and score risk.. F-choline PET/CT is a potential tool for predicting sPCa in patients with persistently increased PSA levels and previous negative biopsies, and also it could improve the performance of score risk in predicting sPCa.

Topics: Aged; Aged, 80 and over; Biopsy; Choline; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms

Topics: Choline; Coronavirus Infections; COVID-19; Disease Progression; Humans; Inflammation; Lung; Macrophages; Male; Middle Aged; Neoplasm Recurrence, Local; Pandemics; Pneumonia, Viral; Positron Emission Tomography Computed Tomography; Prostatectomy; Prostatic Neoplasms

Topics: Aged; Choline; Humans; Incidental Findings; Male; Neurilemmoma; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

Several factors have been identified that predict positive fluorine-18-fluoromethylcholine (F-FCH) PET/CT result in patients with prostate cancer undergoing PET/CT for biochemical failure. Among these factors, prostate-specific antigen (PSA) is the single factor most consistently associated with the prediction of positive F-FCH PET/CT. In this study, we wished to confirm this finding and expand it in a large series of patients.. We retrospectively analyzed 192 patients with prostate cancer who were recruited from the Nuclear Medicine Department of the Sant'Andrea Hospital of La Spezia, Italy, from March 2013 to March 2018 and who underwent F-FCH PET/CT owing to biochemical failure after radical prostatectomy.. Median trigger PSA was 2.57 ng/ml. The overall positive detection rate of F-FCH PET/CT was 60.9%. The percent of positive scans was 30.5% for PSA less than 1 ng/ml, 59.4% (38/64) for PSA between 1 and 5 ng/ml, and 88.4% for PSA greater than 5 ng/ml (P<0.001). On univariate regression analysis, high PSA levels, biochemical failure during antiandrogenic therapy at the time of PET/CT, and older age significantly (P<0.05) predicted positive F-FCH PET/CT result. On multivariate regression analysis, only high PSA levels and biochemical failure during antiandrogenic therapy maintained the statistical significance (P<0.05). However, when the analysis was restricted to patients with PSA less than 1 ng/ml, PSA lost the statistical significance. Receiver operating characteristic analysis revealed an area under the curve of 0.795. The PSA cutoff value that best distinguished PET/CT-positive from PET/CT-negative patients was 2.57 ng/ml. Sensitivity and specificity at this PSA value were 66.7 and 76.0%, respectively.. This study confirms that PSA robustly predicts positive PET/CT result with radiolabeled choline. Unfortunately, this study also confirms the limited sensitivity of F-FCH PET/CT for PSA less than 1 ng/ml, which currently represents the weakest point of the technique.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies; ROC Curve

A 73-year-old man with a prostate cancer treated by radical prostatectomy in 2006. For a biochemical recurrence of disease (prostate-specific antigen level, 0.1 ng/mL) during hormonal therapy, patient underwent F-choline PET/CT that showed a significant uptake in a diffuse right pleural thickening. The patient was sent to pleurectomy decortication showing an epithelioid pleural mesothelioma. This case highlighted that a histopathological evaluation is mandatory in case of a significant radiolabeled choline uptake in pleural lesions.

Topics: Aged; Choline; Humans; Male; Mesothelioma; Pleural Neoplasms; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Recurrence

An 85-year-old man with a 2-year history of prostate cancer, treated with radiotherapy and hormonal therapy, presented increased prostatic-specific antigen levels. F-choline PET/CT showed focal prostatic uptake consistent with known local recurrence, increased uptake of 2 hypodense thyroid nodules and of 2 left cervical lymph nodes, suspected as thyroid cancer. Neck ultrasound confirmed the high risk of malignancy, and a guided biopsy (of a thyroid nodule and cervical lymph node) revealed cellular infiltrates thyroid transcription factor-1 (TTF-1) negative and prostatic-specific antigen positive, confirming intrathyroid and cervical lymph node metastases of prostate cancer. PET/CT changed the disease staging. Chemotherapy was initiated.

Topics: Aged, 80 and over; Choline; Humans; Incidental Findings; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Thyroid Neoplasms

Thyroid incidental uptake is defined as a thyroid uptake incidentally detected by imaging examinations performed for non-thyroid disease. The aim of this study was to establish the prevalence and the pathological nature of focal thyroid incidental uptake (FTIU) among patients studied with 18F-choline-PET/CT.. We retrospectively evaluated 368 patients who performed 18F-choline-PET/CT between June 2016 and August 2018. The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax) and the mean SUV (SUVmean) of the thyroid gland and of the FTIU; every focal thyroid uptake deviating from physiological distribution and background was considered FTIU. Final diagnosis of FTIU was obtained by cytological or histological examination after surgery.. The average SUVmax and SUVmean of thyroid gland in population were 3 and 1.8. Among 368 patients, FTIU was identified in nine cases (2.4%) and eight underwent further investigations to determine the nature. Two FTIU were classified as malignant (thyroid carcinoma), whereas five were benign (three nodular hyperplasia, one follicular adenoma, one Hurtle cell adenoma) and one indeterminate at cytological examination. In malignant lesions, average SUVmax was 9.6 and 4.5, respectively, while average SUVmean was 5.3 and 2.9, respectively. Average SUVmax and SUVmean of benign lesions were 4.9 and 3.2 and of the indeterminate lesion 5 and 3, respectively.. 18F-choline-PET/CT FTIU may be a relevant diagnostic reality, which requires further investigations and affects management, especially considering that, despite being mainly benign, also malignancy is possible.

Topics: Aged; Aged, 80 and over; Choline; Humans; Incidental Findings; Male; Middle Aged; Prostatic Neoplasms; Retrospective Studies; Thyroid Gland

The primary objective of this study was to assess clinical outcomes in patients with oligometastatic prostate cancer recurrence after single or repeated salvage radiation treatment.. Forty-nine consecutive prostate cancer patients diagnosed with oligometastatic recurrence on Ch-PET have been prospectively treated. Seven (23%) patients had castrate-resistant disease. Clinical outcomes were assessed using the Kaplan-Meier method. Potential prognostic factors were examined using univariate proportional hazards regression.. The treatments administered to the initial oligorecurrence sites were intensity-modulated radiotherapy (IMRT) ± ADT (26 patients; 53%) and stereotactic ablative radiotherapy (SABR) ± ADT (23 patients; 47%). With a median follow-up of 24 months (range 6-39), 24 patients developed a biochemical failure. Twenty out of the 24 relapsed patients underwent a second Ch-PET/CT. Seven patients presented poly-metastatic relapse and 10 oligometastatic diseases. Six of 10 patients with a second oligorecurrence were treated again with SABR. Overall, 102 lesions were treated. Local control was detected in 45 (91.8%) patients. No relevant (grade ≥ 2) toxicity was reported, and there was no grade 3 toxicity. On univariate analysis, none of the variables were significantly predicted for clinical disease-free survival. At last follow-up visit, 24 patients (40%) were free from biochemical failure and 37 (71%) patients were free from clinical disease. The 2-year OS and PCSS were 91.8% and 95.9% respectively.. Salvage IMRT or SBRT of oligometastatic prostate cancer recurrence is associated with a prolonged cDFS. This may result in a longer time to develop castrate-resistant disease and a longer time without systemic therapies.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Bone Neoplasms; Carcinoma; Choline; Fluorine Radioisotopes; Humans; Kaplan-Meier Estimate; Lymph Nodes; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Proportional Hazards Models; Prostatic Neoplasms; Prostatic Neoplasms, Castration-Resistant; Radiosurgery; Radiotherapy, Intensity-Modulated; Salvage Therapy

To evaluate the diagnostic performance of a whole-body 18F-choline (FCH) hybrid PET/MRI for prostate cancer patients at biochemical relapse after radical prostatectomy (RP) compared to pelvic multiparametric MRI (mpMRI), one of the standard imaging modality for this patient population. From 2010 to 2016, 58 whole-body FCH PET/MRI studies with mpMRI acquisitions were performed in 53 prostate cancer patients relapsing after curative RP. Median PSA and PSA doubling time (PSA DT) at PET study were 1.5 ng/ml and 6.5 months, respectively. The overall positivity rate of FCH PET/MRI was 58.6% (n = 34), dropping to 44% in patients with a PSA ≤ 2 ng/ml (n = 36). Median PSA values in positive and negative PET/MRI studies were 2.2 ng/ml and 0.8 ng/ml, respectively, with no differences in PSA DT (6.5 vs. 6.6 months). A PSA value ≥ 1.5 ng/ml was a significant predictor of positivity on PET/MRI studies. Compared to PET, mpMRI identified more local relapses (17 vs. 14, p = 0.453) while PET outperformed whole-body Dixon MRI for regional (16 vs. 9, p = 0.016) and distant (12 vs. 6, p = 0.031) metastases. Compared to pelvic mpMRI, the treatment approach turned out to be influenced more frequently using whole-body FCH hybrid PET/MRI studies (58.6% vs. 38%). In prostate cancer patients with biochemical recurrence after RP, whole-body FCH PET/MRI achieved a higher detection rate of nodal/distant metastases compared to pelvic mpMRI alone, increasing the change of treatment strategy by more than 20%.

Topics: Aged; Aged, 80 and over; Choline; Fluorine Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neoplasm Recurrence, Local; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Whole Body Imaging

F-choline PET/CT is increasingly being used during the follow-up of prostate cancer and is bringing us valuable information for the delineation of local and distant nodal recurrence in patients with hormone-resistant poorly differentiated cell types. Lymphatic spreading usually involves pelvic and retroperitoneal levels, being unusual at supraclavicular levels. We report a 75-year-old man with unsuspected involvement of Virchow node from prostate cancer observed using F-choline PET/CT.

Topics: Aged; Choline; Humans; Lymph Nodes; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

Restaging local recurrence after high-intensity focused ultra-sound (HIFU) is based on multiparametric MRI (mpMRI). However, postinterventional changes of the tissue, such as edema or hemorrhage, are limiting tumor detection on mpMRI. We present a case of a rising prostate-specific antigen values, negative mpMRI, and a Gleason score of 4+4 on template biopsy after HIFU. On F-choline PET/MR, high focal uptake was detected at the location of positive biopsy. Re-HIFU based on the fused F-choline PET/MR images was performed, followed by a recurrence-free period of 11 months. Thus, F-choline PET/MR could improve guiding retreatment in patients with recurrence after HIFU.

Topics: Choline; Extracorporeal Shockwave Therapy; Humans; Magnetic Resonance Imaging; Male; Multimodal Imaging; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostatic Neoplasms

The aim of the study was to compare the kinetic analysis of. Sixty-one patients were included. PSA was performed few days before FCH PET/CT. Gleason scoring (GS) was collected from systematic sextant biopsies. FCH PET/CT consisted in a dual phase: early pelvic list-mode acquisition (from 0 to10 min post-injection) and late whole-body acquisition (60 min post-injection). PC volume of interest was drawn using an adaptative thresholding (40% of the maximal uptake) on the late acquisition and projected onto an early static frame of 10 min and each of the 20 reconstructed frames of 30 s. Kinetic analysis was performed using an imaging-derived plasma input function. Early kinetic parameter (K1 as influx) and static parameters (early SUVmean, late SUVmean, and retention index) were extracted and compared to clinicopathological parameters.. K1 was significantly, but moderately correlated with early SUVmean (r = 0.57, p < 0.001) and late SUVmean (r = 0.43, p < 0.001). K1, early SUVmean, and late SUVmean were moderately correlated with PSA level (respectively, r = 0.36, p = 0.004; r = 0.67, p < 0.001; r = 0.51, p < 0.001). Concerning GS, K1 was higher for patients with GS ≥ 4 + 3 than for patients with GS < 4 + 3 (median value 0.409 vs 0.272 min. FCH influx index K1 seems to be related to GS and could be a non-invasive tool to gain further information concerning tumor aggressiveness.

Topics: Aged; Aged, 80 and over; Biological Transport; Choline; Humans; Kinetics; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

To analyze clinical results and quality of life of patients with localized prostate cancer after irradiation of the prostate with an 18F-choline-PET/CT-based simultaneous integrated boost (SIB) in comparison to a control group without SIB.. A total of 134 patients underwent intensity-modulated radiotherapy from 2007-2010. All patients received a total dose of 76 Gy with 2 Gy fractions to the prostate; 67 patients received an additional SIB of 80 Gy. The median follow-up was 65 months. Quality of life was evaluated with the EPIC (Expanded Prostate Cancer Index Composite) questionnaire.. Baseline characteristics were similar in both groups (prostate-specific antigen 11 ng/ml vs. 8 ng/ml, p = 0.20, Gleason score <6 in 36% vs. 46%, p = 0.22, with vs. without SIB). No prostate cancer-related death was observed. No significant difference of quality of life scores was found. The largest difference after 5-6 years in comparison to baseline was reported for sexual bother (mean 15 vs. 17 points with vs. without SIB). Mean urinary scores did not decrease. Bowel bother scores changes were larger in the SIB group (mean 5 vs. 2 points, dependent on SIB volume), with increased bowel problems (15 vs. 2% big/moderate problem with bowel movements, p = 0.03). However, a trend towards higher efficacy with SIB resulted (biochemical recurrence-free survival of 92% vs. 85%, p = 0.17).. The first long-term analysis of patients treated with SIB based on molecular imaging with 18-F-choline-PET/CT showed an excellent biochemical recurrence-free survival, but a larger percentage of bowel problems in comparison to the control group.

Topics: Aged; Aged, 80 and over; Choline; Follow-Up Studies; Humans; Male; Middle Aged; Molecular Imaging; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Quality of Life; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Image-Guided; Radiotherapy, Intensity-Modulated; Surveys and Questionnaires

To evaluate the efficacy of single time-point half-body (skull base to thighs) fluorine-18 choline positron emission tomography-computed tomography (PET-CT) compared to a triple-phase acquisition protocol in the detection of prostate carcinoma recurrence.. Consecutive choline PET-CT studies performed at a single tertiary referral centre in patients with biochemical recurrence of prostate carcinoma between September 2012 and March 2017 were reviewed retrospectively. The indication for the study, imaging protocol used, imaging findings, whether management was influenced by the PET-CT, and subsequent patient outcome were recorded.. Ninety-one examinations were performed during the study period; 42 were carried out using a triple-phase protocol (dynamic pelvic imaging for 20 minutes after tracer injection, half-body acquisition at 60 minutes and delayed pelvic scan at 90 minutes) between 2012 and August 2015. Subsequently following interim review of diagnostic performance, a streamlined protocol and appropriate-use criteria were introduced. Forty-nine examinations were carried out using the single-phase protocol between 2015 and 2017. Twenty-nine (69%) of the triple-phase studies were positive for recurrence compared to 38 (78%) of the single-phase studies. Only one patient who had a single-phase study would have benefited from a dynamic acquisition, they have required no further treatment or imaging and are currently under prostate-specific antigen (PSA) surveillance.. Choline PET-CT remains a useful tool for the detection of prostate recurrence when used in combination with appropriate-use criteria. Removal of dynamic and delayed acquisition phases reduces study time without adversely affecting accuracy. Benefits include shorter imaging time which improves patient comfort, reduced cost, and improved scanner efficiency.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

A 65-year-old man with prostate cancer surgically treated in June 2016 underwent F-choline PET/CT in April 2017 for a biochemical recurrence of disease. PET/CT revealed a high tracer uptake in a solid nodulation near the left masseter muscle with a high SUVmax. The patient underwent both ultrasonography examination and fine needle aspiration cytology that confirmed the presence of an ectopic salivary gland. This case highlights that, in patients undergoing choline PET/CT, a careful analysis of the physiological biodistribution should be made by considering also the presence of accessory salivary glands.

Topics: Aged; Choline; Choristoma; Humans; Incidental Findings; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Salivary Gland Diseases; Ultrasonography

Salvage lymph node dissection (sLND) - performed open or minimally-invasive - is a treatment modality that can be offered to patients with nodal recurrence after radical prostatectomy (RP), especially in times where modern imaging methods like choline- or PSMA-PET/CT are available. Yet, there are only very limited data on the safety and oncological effectiveness of robotic sLND.. We identified 36 patients who underwent robotic sLND at a median time of 45.3 months [range 3.1;228.6] after RP, with nodal recurrences detected in 25 patients by PSMA- and in 11 by choline-PET/CT. Median preoperative PSA, operation time and blood loss were 1.98 ng/ml [range 0.09;35.15], 129.5 min [range 65;202] and 50 ml [range 0;400], respectively. No high-grade complications occurred. A median number of 6.5 [range 1;25] lymph nodes were removed with a median of 1 [range 0;9] tumor-occupied node. None of the patients received any adjuvant treatment. Median postoperative PSA-change was -57% [range -100; +58] in the PSMA- and +10% [range -91; +95] in the choline-group (p = 0.015). 44% of patients in the PSMA- and 18% of patients in the choline-group experienced complete biochemical response (cBCR; PSA <0.2 ng/ml). Median time from sLND to the initiation of further therapy was 12 months [range 2;21.5] in the PSMA-group and 4.7 months [range 2.2;18.9] in the choline-group (p = 0.001).. This is the hitherto largest series on robotic sLND for nodal recurrence after RP. Robotic sLND is a feasible therapeutic option with low morbidity, which can at least delay the initiation of further therapy - in some patients up to several years. However, the extend of sLND has to be standardized and randomized trials are needed to finally define the oncological effectiveness of this approach.

Topics: Aged; Aged, 80 and over; Choline; Follow-Up Studies; Humans; Lymph Node Excision; Lymph Nodes; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prognosis; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Robotic Surgical Procedures; Salvage Therapy; Surgery, Computer-Assisted; Survival Rate

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

We report herein the case of an 80-year-old man who was referred for a biochemical recurrence of a high-risk prostate cancer. In addition to prostate cancer recurrence, F-choline allowed partial initial staging of an incidental diffuse large B-cell lymphoma which was further confirmed and staged using F-FDG and a biopsy. Two types of metabolic behavior were therefore identified using F-choline and F-FDG which corresponded to 2 different uptake patterns, that is, those of the prostate and lymphoma tumoral cell contingents.

Topics: Aged, 80 and over; Choline; Fluorodeoxyglucose F18; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals

This was a retrospective, single-institution study of 32 patients with suspected prostate cancer recurrence who underwent both FCH-PET/CT and 3T mpMRI within 3 months of one another for the detection of recurrence. All included patients had to be cleared for metastatic recurrence. The reference procedure was systematic 3-dimensional (3D)-transperineal prostate biopsy for the final assessment of local recurrence. Both imaging modalities were analyzed by 2 experienced readers blinded to clinical data. The analysis was made per-patient and per-segment using a 4-segment model.. The median prostate-specific antigen value at the time of imaging was 2.92 ng/mL. The mean prostate-specific antigen doubling time was 14 months. Of the 32 patients, 31 had a positive 3D-transperineal mapping biopsy for a local relapse. On a patient-based analysis, the detection rate was 71% (22 of 31) for mpMRI and 74% (23 of 31) for FCH-PET/CT. On a segment-based analysis, the sensitivity and specificity were, respectively, 32% and 87% for mpMRI, 34% and 87% for FCH-PET/CT, and 43% and 83% for the combined analysis of both techniques. Accuracy was 64%, 65%, and 66%, respectively. The interobserver agreement was κ = 0.92 for FCH-PET/CT and κ = 0.74 for mpMRI.. Both mpMRI and FCH-PET/CT show limited sensitivity but good specificity for the detection of local cancer recurrence after radiation therapy, when compared with 3D-transperineal mapping biopsy. Prostate biopsy still seems to be mandatory to diagnose local relapse and select patients who could benefit from local salvage therapy.

Topics: Aged; Biopsy; Choline; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

For patients with oligometastatic recurrence of prostate cancer (PC), stereotactic body radiation therapy (SBRT) represents an attractive treatment option, as it is safe without major side effects. The aim of this study was to investigate the impact of SBRT in delaying the start of androgen deprivation therapy (ADT).. A post-SBRT prostate-specific antigen (PSA) response was seen in 29 (67.4%) of 43 patients. Median ADT-free survival (ADT-FS) was 15.6 months (95% confidence interval [CI], 11.7-19.5) for the whole group, and 25.7 months (95% CI, 9.0-42.4) for patients with a PSA response. Seven patients were treated with a second course of SBRT because of oligometastatic disease recurrence; the ADT-FS in this group was 32.1 months (95% CI, 7.8-56.5). Compared with the control group, the ADT-FS from first diagnosis of metastasis was significantly longer, with 17.3 (95% CI, 13.7-20.9) months versus 4.19 months (95% CI, 0.0-9.0), P < .001. Also, time between diagnosis of the metastasis until progression of disease during ADT use (castration resistance) was longer for the SBRT-treated patients (mean 66.6, 95% CI, 53.5-79.8, vs. 36.41, 95% CI, 26.0-46.8 months, P = .020). There were no grade III or IV adverse events reported.. SBRT can safely and effectively be used to postpone ADT in appropriately selected patients with oligometastatic recurrence of PC.

Topics: Aged; Aged, 80 and over; Androgen Antagonists; Antineoplastic Agents, Hormonal; Choline; Combined Modality Therapy; Disease-Free Survival; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasms, Second Primary; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiosurgery; Retrospective Studies; Time-to-Treatment; Treatment Outcome

FDG PET is known to have a low sensitivity for the detection of prostate and bladder tumors because of high levels of urinary excretion, which potentially obscures sites of disease. Fluoromethylcholine PET has a higher sensitivity for the detection of metastatic prostate cancer compared with F-FDG PET, partly because of lower levels of urinary excretion. We present a case of a patient who underwent F-fluoromethylcholine PET for possible recurrent prostate cancer. The study identified an incidental, avid metachronous bladder tumor. We discuss the potential use of fluoromethylcholine PET in the detection of bladder tumors.

Topics: Aged; Carcinoma, Papillary; Choline; Humans; Incidental Findings; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence; Urinary Bladder Neoplasms

Prostate carcinoma is the most common cancer in men. After local therapy, disease recurs in many patients. A choline PET/CT is indicated in case of biochemical relapse of prostate carcinoma to determine the site of recurrence (local and/or distant) and to help select the next line of therapy. Choline PET-CT is also known to show an elevated uptake in hyperfunctioning parathyroid adenoma. This case report shows the difficulty to distinguish between both entities if they occur simultaneously in an oncologic patient.

Topics: Adenoma; Carcinoma; Choline; Diagnosis, Differential; Humans; Lymphatic Metastasis; Male; Middle Aged; Parathyroid Neoplasms; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals

Topics: Carbon Radioisotopes; Choline; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Neoplasm Staging; Oligopeptides; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radioactive Tracers

Patients with suspected recurrence of prostate cancer undergoing [18F]fluoromethyl choline ([18F]FCH) PET/CT were retrospectively evaluated to investigate the influence of hormonal therapy (HT) in [18F]FCH uptake.. [18F]FCH PET/CT was performed in 102 surgically treated patients with suspected recurrence (PSA increase >0.2 ng/mL) of prostate cancer, divided in two groups: under HT (N.=54) and without HT (N.=48) at the time of PET scanning. PET/CT was carried out by an integrated system (Biograph 6, CTI/Siemens, Knoxville, TN, USA) intravenously by administering 4.1 MBq/kg of [18F]FCH to each patient; images were acquired 60 minutes later.. On the total number of patients, 66 were found to be true positives (TP), 9 false positives (FP), 5 false negatives (FN) and 22 true negatives (TN), sensitivity to [18F]FCH PET/CT was 93%, specificity 71%, accuracy 86%, positive predictive value (PPV) 88%, negative predictive value (NPV) 81%. In the 54 patients under HT, 38 were TP, 6 FP, 3 FN and 7 TN, sensitivity was 93%, specificity 54%, accuracy 83%, PPV 86% and NPV was 70%. In the 48 patients receiving no HT, 28 were TP, 3 FP, 2 FN and 15 TN, sensitivity was 93%, specificity 83%, accuracy 90%, PPV 90% and NPV 88%. A χ2 test showed that sensitivity, accuracy and PPV did not differ among patients with and without HT, while specificity and NPV were significantly lower (P<0.001) in HT treated patients.. Sensitivity, accuracy and PPV were similar in patients with and without HT. Specificity and NPV were reduced in patients under HT, but further data are necessary to support if this reduction is casual or related to therapy and it could be confirmed in a larger series of patients.

Topics: Aged; Aged, 80 and over; Biological Transport; Choline; Hormones; Humans; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Recurrence; Retrospective Studies

F-choline PET/CT was performed for suspected prostate cancer relapse in a 67-year-old man with hip pain and a rapid rise in prostate-specific antigen values (1.1 ng/mL). PET imaging showed an area of increased F-choline bone uptake in the right ischium. Coregistered CT images showed a lytic bone lesion. The infrequent CT appearance of a possible prostate carcinoma metastasis led to additional laboratory testing that showed a monoclonal γ-peak and to subsequent biopsy, which revealed a solitary plasmocytoma.

Topics: Aged; Bone Neoplasms; Carcinoma; Choline; Humans; Incidental Findings; Male; Multiple Myeloma; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals

Investigating the value of Ga-PSMA-PET/CT in biochemically recurring prostate cancer patients with negative F-choline-PET/CT.. One hundred thirty-nine consecutive patients with biochemical recurrence after curative (surgery and/or radiotherapy) therapy were offered participation in this sequential clinical imaging approach. Patients first underwent an F-choline-PET/CT. If negative, an additional Ga-PSMA-PET/CT was offered. One hundred twenty-five of 139 eligible patients were included in the study; 32 patients underwent additional Ga-PSMA-PET/CT. Patients with equivocal findings (n = 5) on F-choline-PET/CT and those who declined the additional Ga-PSMA-PET/CT (n = 9) were excluded. Images were analyzed visually for the presence of suspicious lesions. Findings on PET/CT were correlated with PSA level, PSA doubling time (dt), and PSA velocity (vel).. The overall detection rates were 85.6% (107/125) for the sequential imaging approach and 74.4% (93/125) for F-choline-PET/CT alone. Ga-PSMA-PET/CT detected sites of recurrence in 43.8% (14/32) of the choline-negative patients. Detection rates of the sequential imaging approach and F-choline-PET/CT alone increased with higher serum PSA levels and PSA vel. Subgroup analysis of Ga-PSMA-PET/CT in F-choline negative patients revealed detection rates of 28.6%, 45.5%, and 71.4% for PSA levels of 0.2 or greater to less than 1 ng/mL, 1 to 2 ng/mL, and greater than 2 ng/mL, respectively.. The sequential imaging approach designed to limit Ga-PSMA imaging to patients with negative choline scans resulted in high detection rates. Ga-PSMA-PET/CT identified sites of recurrent disease in 43.8% of the patients with negative F-choline PET/CT scans.

Topics: Aged; Aged, 80 and over; Antigens, Surface; Choline; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

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

We report the incidental finding of a pituitary macroadenoma on an F-choline PET/CT in a patient with recurrent prostate cancer. The pituitary gland was clearly enlarged and intensely FDG avid (SUVmax, 6.6). The diagnosis was confirmed by a subsequent contrast-enhanced MR evaluation, and the macroadenoma was classified as nonfunctioning on the basis of normality of the specific serum hormonal profile. A follow-up F-choline PET/CT scan performed after 6 months revealed stable dimension, and uptake of the pituitary macroadenoma patient deceased 1 month later. At autopsy, intracytoplasmic vesicles containing growth and prolactin hormones were observed at immunohistochemistry.

Topics: Adenoma; Choline; Humans; Incidental Findings; Male; Middle Aged; Pituitary Neoplasms; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence

A 79-year-old man underwent F-choline PET/CT for biochemical recurrence of prostate cancer. PET/CT images showed an area of elevated radiopharmaceutical uptake in a left pelvic node. In addition, a small focus of increased radiolabeled choline accumulation was seen in a small nodule of the right breast, which was later histologically characterized as an infiltrating ductal carcinoma. In this patient, choline PET/CT was critical in localizing prostate cancer recurrence and identifying a second unsuspected malignancy.

Topics: Aged; Breast Neoplasms, Male; Carcinoma; Choline; Humans; Incidental Findings; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals

To evaluate and compare the utility of 18F-fluorocholine (18F-CH) PET/CT versus 3-Tesla multiparametric MRI (mpMRI) without endorectal coil to detect tumor recurrences in patients with biochemical relapse following radical prostatectomy (RP). Secondarily, to identify possible prognostic variables associated with mpMRI and 18F-CH PET/CT findings.. Retrospective study of 38 patients who developed biochemical recurrence after RP between the years 2011 and 2015 at our institution. PET/CT and mpMRI were both performed within 30 days of each other in all patients. The PET/CT was reviewed by a nuclear medicine specialist while the mpMRI was assessed by a radiologist, both of whom were blinded to outcomes.. The median prostate-specific antigen (PSA) value pre-MRI/PET-CT was 0.9 ng/mL (interquartile range 0.4-2.2 ng/mL). There were no differences in the detection rate between 18F-CH PET/CT and mpMRI for local recurrence (LR), lymph node recurrence (LNR) and bone metastases (BM). Separately, mpMRI and 18F-CH PET/CT were positive for recurrence in 55.2% and 52.6% of cases, respectively, and in 65.7% of cases when findings from both modalities were considered together. The detection of LR was better with combined mpMRI and choline PET/CT versus choline PET/CT alone (34.2% vs 18.4%, p = 0.04). Salvage treatment was modified in 22 patients (57.8%) based on the imaging findings. PSA values on the day of biochemical failure were significantly associated with mpMRI positivity (adjusted odds ratio (OR): 30.9; 95% confidence interval (CI): 1.5-635.8). Gleason score > 7 was significantly associated with PET/CT positivity (OR: 13.9; 95% CI: 1.5-125.6). A significant association was found between PSA doubling time (PSADT) (OR: 1.3; 95% CI: 1.0-1.7), T stage (OR: 21.1; 95% CI: 1.6-272.1), and LR.. Multiparametric MRI and 18F-CH PET/CT yield similar detection rates for LR, LNR and pelvic BM. The combination of both imaging techniques provides a better LR detection versus choline PET/CT alone. The initially planned salvage treatment was modified in 57.8% of patients due to imaging findings. In addition to PSA values, Gleason score, T stage, and PSADT may provide valuable data to identify those patients that are most likely to benefit from undergoing both imaging procedures.

Topics: Aged; Choline; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals

We report a case of squamous cell carcinoma of the tonsil incidentally detected by F-choline PET/CT. A 55-year-old male patient with a history of prostate cancer underwent F-choline PET/CT for restaging. PET/CT revealed a focal area of increased F-choline uptake corresponding to the left tonsil. No other areas of abnormal F-choline uptake were detected in the rest of the body. Based on these PET/CT findings, the patient underwent clinical examination and biopsy of the left tonsil. Histology demonstrated the presence of a squamous cell carcinoma of the tonsil.

Topics: Carcinoma, Squamous Cell; Choline; Humans; Incidental Findings; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed; Tonsillar Neoplasms

The objective of the present study is to determine whether uptake of [(18)F]fluoromethylcholine ([(18)F]FCH) in comparison with 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) accurately reflects chemotherapy efficacy at the tumor cell level in prostate cancer (PC).. The effects of docetaxel and cabazitaxel on viable tumor cell number were explored in four PC cell lines. Cellular uptake of [(18)F]FDG and [(18)F]FCH was compared with the effects measured using sulforhodamine B (SRB) assay, cell counting and colony formation assay (CFA), as proximators of viable tumor cell number. Agreement between uptake and cell numbers was assessed by Bland-Altman plots.. [(18)F]FCH uptake in all PC cell lines significantly correlated to the cell numbers surviving the respective drug concentrations. Bland-Altman analysis showed that [(18)F]FDG uptake resulted in signal overestimation and higher variability after chemotherapy.. [(18)F]FCH uptake correlates well with viable tumor cell numbers remaining after docetaxel and cabazitaxel exposure. Radiolabeled choline is a potential response monitoring biomarker after chemotherapy for PC.

Topics: Antineoplastic Agents; Cell Line, Tumor; Choline; Docetaxel; Drug Screening Assays, Antitumor; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Inhibitory Concentration 50; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Rhodamines; Taxoids

Topics: Choline; Humans; Male; Neoplasm Grading; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

The objective of this study was to explore the ability of the initial Gleason score (GS) to predict the rate of detection of recurrent prostate cancer (PCa) with (18)F-choline PET/CT in a large cohort of patients.. Data from 1,000 patients who had undergone (18)F-choline PET/CT because of biochemical evidence of relapse of PCa between 2004 and 2013 were retrieved from databases at 4 centers. Continuous data were compared by the Student t test or ANOVA, and categoric variables were compared by the χ(2) test. Univariable and multivariable analyses were performed by logistic regression.. The GS at diagnosis was less than or equal to 6 in 257 patients, 7 in 347 patients, and greater than 7 in 396 patients. The results of 645 PET/CT scans were positive for PCa recurrence. Eighty-one percent of the positive PET/CT results were found in patients with a PSA level of greater than or equal to 2 ng/mL, 43% were found in patients with a PSA level of 1-2 ng/mL, and 31% were found in patients with a PSA level of less than or equal to 1 ng/mL; 78.8% of patients with positive PET/CT results had a GS of greater than 7. The results of (18)F-choline PET/CT scans were negative in 300 patients; 44% had a GS of less than or equal to 6, 35% had a GS of 7, and 17% had a GS of greater than 7. PET/CT results were rated as doubtful in only 5.5% of patients (median PSA, 1.8 ng/mL). When the GS was greater than 7, the rates of detection of (18)F-choline PET/CT were 51%, 65%, and 91% for a PSA level of less than 1 ng/mL, 1-2 ng/mL, and greater than 2 ng/mL, respectively. In univariable and multivariable analyses, both a GS of 7 and a GS of greater than 7 were independent predictors for positive (18)F-choline PET/CT results (odds ratios, 0.226 and 0.330, respectively; P values for both, <0.001).. A high GS at diagnosis is a strong predictive factor for positive (18)F-choline PET/CT scan results for recurrent PCa, even when the PSA level is low (i.e., ≤1 ng/mL).

Topics: Aged; Analysis of Variance; Biopsy; Choline; Humans; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Neoplasm Recurrence, Local; Positron-Emission Tomography; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Regression Analysis; Retrospective Studies; Risk; ROC Curve; Tomography, X-Ray Computed

Brain metastases are a rare complication of prostate cancer. They are usually diagnosed in an end-stage disease when the tumor has already spread to the other organs and tissues. We present a case of a male with castration-resistant prostate cancer with bone metastases visualized in ¹⁸F-fluorocholine PET/CT scan.

Topics: Aged; Brain Neoplasms; Choline; Humans; Male; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

Choline kinase is upregulated in prostate cancer, resulting in increased (18)F-fluoromethylcholine uptake. This study used pharmacokinetic modeling to validate the use of simplified methods for quantification of (18)F-fluoromethylcholine uptake in a routine clinical setting.. Forty-minute dynamic PET/CT scans were acquired after injection of 204 ± 9 MBq of (18)F-fluoromethylcholine, from 8 patients with histologically proven metastasized prostate cancer. Plasma input functions were obtained using continuous arterial blood-sampling as well as using image-derived methods. Manual arterial blood samples were used for calibration and correction for plasma-to-blood ratio and metabolites. Time-activity curves were derived from volumes of interest in all visually detectable lymph node metastases. (18)F-fluoromethylcholine kinetics were studied by nonlinear regression fitting of several single- and 2-tissue plasma input models to the time-activity curves. Model selection was based on the Akaike information criterion and measures of robustness. In addition, the performance of several simplified methods, such as standardized uptake value (SUV), was assessed.. Best fits were obtained using an irreversible compartment model with blood volume parameter. Parent fractions were 0.12 ± 0.4 after 20 min, necessitating individual metabolite corrections. Correspondence between venous and arterial parent fractions was low as determined by the intraclass correlation coefficient (0.61). Results for image-derived input functions that were obtained from volumes of interest in blood-pool structures distant from tissues of high (18)F-fluoromethylcholine uptake yielded good correlation to those for the blood-sampling input functions (R(2) = 0.83). SUV showed poor correlation to parameters derived from full quantitative kinetic analysis (R(2) < 0.34). In contrast, lesion activity concentration normalized to the integral of the blood activity concentration over time (SUVAUC) showed good correlation (R(2) = 0.92 for metabolite-corrected plasma; 0.65 for whole-blood activity concentrations).. SUV cannot be used to quantify (18)F-fluoromethylcholine uptake. A clinical compromise could be SUVAUC derived from 2 consecutive static PET scans, one centered on a large blood-pool structure during 0-30 min after injection to obtain the blood activity concentrations and the other a whole-body scan at 30 min after injection to obtain lymph node activity concentrations.

Topics: Aged; Calibration; Choline; Humans; Kinetics; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Metastasis; Positron-Emission Tomography; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Regression Analysis; Time Factors; Tomography, X-Ray Computed

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

Metastases to the larynx from prostate carcinoma are rare. We describe a case of asymptomatic prostate carcinoma metastasis to the right cricoid cartilage detected on 18F-fluorocholine PET/CT. This was histologically proven on open biopsy and the patient was offered local radiotherapy.

Topics: Choline; Humans; Incidental Findings; Laryngeal Neoplasms; Larynx; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

This study evaluated expected tumor control and normal tissue toxicity for prostate volumetric modulated arc therapy (VMAT) with and without radiation boosts to an intraprostatically dominant lesion (IDL), defined by (18)F-choline positron emission tomography/computed tomography (PET/CT).. Thirty patients with localized prostate cancer underwent (18)F-choline PET/CT before treatment. Two VMAT plans, plan79 Gy and plan100-105 Gy, were compared for each patient. The whole-prostate planning target volume (PTVprostate) prescription was 79 Gy in both plans, but plan100-105 Gy added simultaneous boost doses of 100 Gy and 105 Gy to the IDL, defined by 60% and 70% of maximum prostatic uptake on (18)F-choline PET (IDLsuv60% and IDLsuv70%, respectively, with IDLsuv70% nested inside IDLsuv60% to potentially enhance tumor specificity of the maximum point dose). Plan evaluations included histopathological correspondence, isodose distributions, dose-volume histograms, tumor control probability (TCP), and normal tissue complication probability (NTCP).. Planning objectives and dose constraints proved feasible in 30 of 30 cases. Prostate sextant histopathology was available for 28 cases, confirming that IDLsuv60% adequately covered all tumor-bearing prostate sextants in 27 cases and provided partial coverage in 1 case. Plan100-105 Gy had significantly higher TCP than plan79 Gy across all prostate regions for α/β ratios ranging from 1.5 Gy to 10 Gy (P<.001 for each case). There were no significant differences in bladder and femoral head NTCP between plans and slightly lower rectal NTCP (endpoint: grade ≥ 2 late toxicity or rectal bleeding) was found for plan100-105 Gy.. VMAT can potentially increase the likelihood of tumor control in primary prostate cancer while observing normal tissue tolerances through simultaneous delivery of a steep radiation boost to a (18)F-choline PET-defined IDL.

Topics: Aged; Aged, 80 and over; Alpha Particles; Beta Particles; Choline; Feasibility Studies; Femur Head; Fluorine Radioisotopes; Humans; Male; Middle Aged; Multimodal Imaging; Organs at Risk; Penis; Positron-Emission Tomography; Prostate; Prostatic Neoplasms; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Image-Guided; Radiotherapy, Intensity-Modulated; Rectum; Tomography, X-Ray Computed; Tumor Burden; Urinary Bladder

Combined PET/CT scanning with (18)F-FDG is in current use in Hodgkin lymphoma. New tracers have been developed, such as (18)F-choline in prostate cancer. Its use is under investigation in other solid tumors (eg, brain, liver, lung). We report a case of Hodgkin lymphoma incidentally detected on (18)F-choline PET/CT in a prostate cancer patient and show a comparison with (18)F-FDG PET/CT. (18)F-choline PET/CT detected more lymph node lesions than the (18)F-FDG PET/CT for this patient. Comparative studies of the 2 tracers might help fine-tune treatments and, in particular, delineate target zones in radiation therapy.

Topics: Aged; Choline; Fluorodeoxyglucose F18; Hodgkin Disease; Humans; Incidental Findings; Male; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

Aim of the study is to evaluate the impact of Cho-PET/CT in decision-making strategy of patients with localized prostate cancer (PC) eligible to definitive radiotherapy (RT).. Sixty patients Cho-PET/CT before RT were prospectively enrolled. All patients were treated with volumetric modulated arc therapy with simultaneous integrated boost in 28 fractions. Androgen deprivation therapy was prescribed according to National Comprehensive Cancer Network (NCCN) risk classification. Therapeutic strategy based on the Cho-PET/CT evaluation was compared with the strategy that would have been proposed in case of PET not available and/or not strictly indicated, according to international and national PC guidelines.. Cho-PET/CT was positive in 57 cases (95%): T in 45 (79%); T in combination with N in 8 (14%); and M (bone) in combination with T or N, or both, in 4 (7%). After Cho-PET/CT, patients were stratified as follows: 26 (43%) low risk, 10 (16%) intermediate risk, and 24 (41%) high risk. Cho-PET/CT shifted treatment indication in 13 cases (21%). The changes regarding radiation treatment volumes were as follows: 6 intermediate risk (10%) shifted to high risk and consequently were irradiated on prostate, seminal vesicles, and pelvic nodes PTVs; in 7 high risk (11%), the Cho-PET/CT showed bone and/or N uptake, and consequently, a simultaneous integrated boost on PET positive sites was prescribed.. Cho-PET/CT seems to be a promising diagnostic tool in patients who are candidates for radical RT and supporting the decision making in treatment planning, in particular in intermediate-high risk.

Topics: Aged; Choline; Clinical Decision-Making; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy, Intensity-Modulated; Tomography, X-Ray Computed

In prostate cancer with biochemical failure after therapy, current imaging techniques have a low detection rate at the prostate-specific antigen (PSA) levels at which targeted salvage therapy is effective. (11)C-choline and (18)F-fluoromethylcholine, though widely used, have poor sensitivity at low PSA levels. (68)Ga-PSMA (Glu-NH-CO-NH-Lys-(Ahx)-[(68)Ga-N,N'-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N'-diacetic acid]) has shown promising results in retrospective trials. Our aim was to prospectively compare the detection rates of (68)Ga-PSMA versus (18)F-fluoromethylcholine PET/CT in men who were initially managed with radical prostatectomy, radiation treatment, or both and were being considered for targeted therapy.. A sample of men with a rising PSA level after treatment, eligible for targeted treatment, was prospectively included. Patients on systemic treatment were excluded. (68)Ga-PSMA, (18)F-fluoromethylcholine PET/CT, and diagnostic CT were performed sequentially on all patients between January and April 2015, and the images were assessed by masked, experienced interpreters. The findings and their impact on management were documented, together with the results of histologic follow-up when feasible.. In total, 38 patients were enrolled. Of these, 34 (89%) had undergone radical prostatectomy and 4 (11%) had undergone radiation treatment. Twelve (32%) had undergone salvage radiation treatment after primary radical prostatectomy. The mean PSA level was 1.74 ± 2.54 ng/mL. The scan results were positive in 26 patients (68%) and negative with both tracers in 12 patients (32%). Of the 26 positive scans, 14 (54%) were positive with (68)Ga-PSMA alone, 11 (42%) with both (18)F-fluoromethylcholine and (68)Ga-PSMA, and only 1 (4%) with (18)F-fluoromethylcholine alone. When PSA was below 0.5 ng/mL, the detection rate was 50% for (68)Ga-PSMA versus 12.5% for (18)F-fluoromethylcholine. When PSA was 0.5-2.0 ng/mL, the detection rate was 69% for (68)Ga-PSMA versus 31% for (18)F-fluoromethylcholine, and when PSA was above 2.0, the detection rate was 86% for (68)Ga-PSMA versus 57% for (18)F-fluoromethylcholine. On lesion-based analysis, (68)Ga-PSMA detected more lesions than (18)F-fluoromethylcholine (59 vs. 29, P < 0.001). The tumor-to-background ratio in positive scans was higher for (68)Ga-PSMA than for (18)F-fluoromethylcholine (28.6 for (68)Ga-PSMA vs. 9.4 for (18)F-fluoromethylcholine, P < 0.001). There was a 63% (24/38 patients) management impact, with 54% (13/24 patients) being due to (68)Ga-PSMA imaging alone. Histologic follow-up was available for 9 of 38 patients (24%), and 9 of 9 (68)Ga-PSMA-positive lesions were consistent with prostate cancer ((68)Ga-PSMA was true-positive). The lesion positive on (18)F-fluoromethylcholine imaging and negative on (68)Ga-PSMA imaging was shown at biopsy to be a false-positive (18)F-fluoromethylcholine finding ((68)Ga-PSMA was true-negative).. In patients with biochemical failure and a low PSA level, (68)Ga-PSMA demonstrated a significantly higher detection rate than (18)F-fluoromethylcholine and a high overall impact on management.

Topics: Aged; Aged, 80 and over; Antigens, Surface; Biopsy; Choline; False Positive Reactions; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prospective Studies; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Salvage Therapy; Tomography, X-Ray Computed; Treatment Outcome

The aim of this study was to assess the value of combining MRI and F-fluorocholine (FCH) PET/CT for patients with a biochemical relapse (BR) after prostate radiotherapy or brachytherapy.. All patients with a BR (BR definition: nadir prostate-specific antigen, +2 ng/mL) had a multiparametric MRI and FCH PET/CT if there was no clinical sign of relapse. Identification of the relapse was considered positive if both imaging techniques were concordant or in case of pathological relapse confirmation.. Sixty-five consecutive patients were analyzed. Initial treatment was external beam radiation therapy (EBRT; n = 40), surgery followed by EBRT (n = 11), or brachytherapy (n = 14). Gleason score was 6 in 23 patients, 7 in 35 patients, and 8 to 10 in 7 patients. Median prostate-specific antigen value at the time of relapse was 7.6 ng/mL. Determination of relapse location was identified in 46 patients (70.7%). Relapses were only local in 24 patients (37%), nodal in 16 (24.6%), and distant in 9 (14%). In 4 cases, MRI showed a local relapse not seen by FCH PET/CT. Among the 24 patients with an isolated local relapse, 13 underwent a confirmatory biopsy and 9 were positive. At the end, only 7 patients (11%) could have a salvage local treatment: cryotherapy of the prostate in 6 cases and 1 nodal EBRT.. In case of BR after radiotherapy or brachytherapy, combining MRI and FCH PET/CT could identify the site of relapse in 70% of patients. This could facilitate the selection of the patients for local salvage treatment.

Topics: Aged; Case-Control Studies; Choline; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

The aim of this study was to observe and characterize the nonspecific ¹⁸F-choline lymph node uptake in patients with prostate cancer.. In this single center, prospective observational study which was done in University Hospital Center Zagreb between December 2012 and October 2014, 69 patients (median age 71 years; range 50-92) with prostate cancer were included. Patients underwent ¹⁸F-choline PET/CT for staging or restaging of prostate cancer. The mean follow-up period was 11.5 months. Kruskal-Wallis test was used to find out if the differences between SUV values of specific and nonspecific accumulation of the tracer are statistically significant.. Nonspecific accumulation of ¹⁸F-choline in lymph nodes was found in 36 patients (52.7%). Most of these findings (n = 24) were nonspecific accumulation of the tracer in mediastinal lymph nodes. Other sites of nonspecific tracer uptake were pulmonary hila (n = 20), inguinal lymph nodes (n = 15), and axillary lymph nodes (n = 10). Mean SUV values for mediastinal lymph nodes, pulmonary hila, axillary and inguinal lymph nodes were 4.8, 4.3, 3.1 and 4.1, respectively. Mean SUV value of nonspecific sites of tracer accumulation was lower (not significantly; (p = 0.2) than tracer uptake values measured in metastases sites (bone metastases mean SUVmax value - 13.2, metastatic lymph nodes mean SUVmax value - 9.2).. ¹⁸F-choline PET/CT is a valuable and an established functional diagnostic imaging method for staging and restaging prostate cancer. However, nonspecific uptake of the tracer can often be seen in lymph nodes not related to primary disease. Patient history, clinical examination, laboratory tests and correlation with other imaging methods, must be taken into consideration when interpreting ¹⁸F-choline PET/CT findings.

Topics: Aged; Aged, 80 and over; Biological Transport; Choline; Humans; Lymph Nodes; Male; Middle Aged; Prospective Studies; Prostatic Neoplasms

To determine when 18F-choline PET/CT can truly identify local recurrence of prostate cancer.. 1031 patients from 3 European centers underwent (18)F-choline PET/CT (FCH PET/CT) for recurrent disease; 131 subjects (12.7%) showed a positive FCH uptake in the prostatic gland or prostatic fossa. Median age was 72 years (range 48-87 years), and the median PSA level at the time of FCH PET/CT scan was 4.41 ng/mL (0.22-18.13 ng/mL). 45 patients (34.4%) had a Gleason score (GS) >7, and the residual subjects had a GS ≤ 7. The assessment of true or false-positive FCH PET/CT findings was made by magnetic resonance imaging (n = 34) and/or biopsy in 75/131 cases. A χ (2) test and a Z Kolmogorov-Smirnov test were used to assess the correlation between clinical variables (age, PSA, GS, type of therapy) and FCH PET/CT findings.. FCH PET/CT resulted truly positive (TP) for recurrent disease in the prostatic gland/fossa in 59/75 patients (79%) and falsely positive (FP) in 16 subjects (21%). The median value of PSA at the time of FCH PET/CT scan was higher in TP as compared to FP, although not statistically significant (4.76 vs. 3.04 ng/mL p > 0.05). Similarly, median age, GS categories, and the type of therapy were similar between the two groups (p > 0.05). However, when matching GS categories and PSA values, we found that the number of patients with TP findings were higher in the case of a PSA > 2 ng/mL, independently from the GS (ranging between 74% and 92%). Conversely, FP rate ranged between 50% and 65% in patients with a PSA ≤ 2 ng/mL, especially in the case of GS ≤ 7, whereas FP was around 25% in those with a GS >7 and PSA > 2 ng/mL.. FCH PET/CT has a limited role in evaluation of prostatic gland/fossa recurrence, due to the physiological biodistribution of the radiopharmaceutical agent. However, in 70-90% of patients with a PSA >2 ng/mL, independently from GS, a focal FCH uptake is compatible with a true local recurrence.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Tomography, X-Ray Computed

Positron emission tomography (PET) with choline tracers has found widespread use for the diagnosis of prostate cancer (PC). However, choline metabolism is not increased in a considerable number of cases, whereas prostate-specific membrane antigen (PSMA) is overexpressed in most PCs. Therefore, a (68)Ga-labelled PSMA ligand could be superior to choline tracers by obtaining a high contrast. The aim of this study was to compare such a novel tracer with standard choline-based PET/CT.. Thirty-seven patients with biochemical relapse of PC [mean prostate-specific antigen (PSA) 11.1 ± 24.1 ng/ml, range 0.01-116] were retrospectively analysed after (18)F-fluoromethylcholine and (68)Ga-PSMA PET/CT within a time window of 30 days. Radiotracer uptake that was visually considered as PC was semi-quantitatively analysed by measuring the maximum standardized uptake values (SUVmax) of the scans acquired 1 h after injection of (68)Ga-PSMA complex solution (median 132 MBq, range 59-263 MBq) and (18)F-fluoromethylcholine (median 237 MBq, range 114-374 MBq), respectively. In addition, tumour to background ratios were calculated.. A total of 78 lesions characteristic for PC were detected in 32 patients using (68)Ga-PSMA PET/CT and 56 lesions were detected in 26 patients using choline PET/CT. The higher detection rate in (68)Ga-PSMA PET/CT was statistically significant (p=0.04). In five patients no lesion was found with both methods. All lesions detected by (18)F-fluoromethylcholine PET/CT were also seen by (68)Ga-PSMA PET/CT. In (68)Ga-PSMA PET/CT SUVmax was clearly (>10 %) higher in 62 of 78 lesions (79.1 %) and the tumour to background ratio was clearly (>10 %) higher in 74 of 78 lesions (94.9 %) when compared to (18)F-fluoromethylcholine PET/CT.. (68)Ga-PSMA PET/CT can detect lesions characteristic for PC with improved contrast when compared to standard (18)F-fluoromethylcholine PET/CT, especially at low PSA levels.

Topics: Aged; Aged, 80 and over; Antigens, Surface; Choline; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Humans; Ligands; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Recurrence; Tomography, X-Ray Computed

Topics: Antigens, Surface; Choline; Glutamate Carboxypeptidase II; Humans; Male; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

The aim of this study was to evaluate the positron emission tomography (PET) component of [(18)F]choline PET/MRI and compare it with the PET component of [(18)F]choline PET/CT in patients with histologically proven prostate cancer and suspected recurrent prostate cancer.. Thirty-six patients were examined with simultaneous [(18)F]choline PET/MRI following combined [(18)F]choline PET/CT. Fifty-eight PET-positive lesions in PET/CT and PET/MRI were evaluated by measuring the maximum and mean standardized uptake values (SUVmax and SUVmean) using volume of interest (VOI) analysis. A scoring system was applied to determine the quality of the PET images of both PET/CT and PET/MRI. Agreement between PET/CT and PET/MRI regarding SUVmax and SUVmean was tested using Pearson's product-moment correlation and Bland-Altman analysis.. All PET-positive lesions that were visible on PET/CT were also detectable on PET/MRI. The quality of the PET images was comparable in both groups. Median SUVmax and SUVmean of all lesions were significantly lower in PET/MRI than in PET/CT (5.2 vs 6.1, p<0.05 and 2.0 vs 2.6, p<0.001, respectively). Pearson's product-moment correlation indicated highly significant correlations between SUVmax of PET/CT and PET/MRI (R=0.86, p<0.001) as well as between SUVmean of PET/CT and PET/MRI (R=0.81, p<0.001). Bland-Altman analysis revealed lower and upper limits of agreement of -2.77 to 3.64 between SUVmax of PET/CT vs PET/MRI and -1.12 to +2.23 between SUVmean of PET/CT vs PET/MRI.. PET image quality of PET/MRI was comparable to that of PET/CT. A highly significant correlation between SUVmax and SUVmean was found. Both SUVmax and SUVmean were significantly lower in [(18)F]choline PET/MRI than in [(18)F]choline PET/CT. Differences of SUVmax and SUVmean might be caused by different techniques of attenuation correction. Furthermore, differences in biodistribution and biokinetics of [(18)F]choline between the subsequent examinations and in the respective organ systems have to be taken into account.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Choline; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Recurrence; Time Factors; Tomography, X-Ray Computed

To compare the diagnostic accuracy of the following imaging techniques in the detection of spine metastases, using magnetic resonance imaging (MRI) as a reference: whole-body bone scintigraphy (WBS) with technetium-99m-MDP, [18F]-sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and [(18) F]-fluoromethylcholine (FCH) PET/CT.. The study entry criteria were biopsy-proven prostate cancer, a positive WBS consistent with bone metastases, and no history of androgen deprivation. Within 30 days of informed consent, trial scans were performed in random order. Scans were interpreted blindly for the purpose of a lesion-based analysis. The primary target variable was bone lesion (malignant/benign) and the 'gold standard' was MRI.. A total of 50 men were recruited between May 2009 and March 2012. Their mean age was 73 years, their median PSA level was 84 ng/mL, and the mean Gleason score of the tumours was 7.7. A total of 46 patients underwent all four scans, while four missed one PET/CT scan. A total of 526 bone lesions were found in the 50 men: 363 malignant and 163 non-malignant according to MRI. Sensitivity, specificity, positive and negative predictive values and accuracy were: WBS: 51, 82, 86, 43 and 61%; NaF-PET/CT: 93, 54, 82, 78 and 81%; and FCH-PET/CT: 85, 91, 95, 75 and 87%, respectively.. We found that FCH-PET/CT and NaF-PET/CT were superior to WBS with regard to detection of prostate cancer bone metastases within the spine. The present results call into question the use of WBS as the method of choice in patients with hormone-naïve prostate cancer.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Multimodal Imaging; Positron-Emission Tomography; Prospective Studies; Prostatic Neoplasms; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In the present short communication we considered the main publications focused on trigger prostate-specific antigen (PSA) and PSA kinetics that systematically compared 18F to 11C-choline PET/CT in order to establish the optimal time to perform choline PET/CT in relation to the trigger values and velocity, as well as doubling time of PSA serum levels.

Topics: Carbon Radioisotopes; Choline; Fluorine Radioisotopes; Humans; Male; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiography

To evaluate if the detection rate (DR) of (18)F-choline (18F-CH) PET/CT is influenced by androgen-deprivation therapy (ADT) in patients with prostate cancer (PC) already treated with radical intent and presenting biochemical relapse.. We have retrospectively evaluated (18)F-CH PET/CT scans of 325 consecutive PC patients enrolled in the period November 2009 to December 2012 previously treated with radical intent and referred to our centre to perform (18)F-CH PET/CT for biochemical relapse. Two different groups of patients were evaluated. group A included the whole sample of 325 patients (mean age 70 years, range: 49-86) who presented trigger PSA between 0.1 and 80 ng/ml (mean 5.5 ng/ml), and group B included 187 patients (mean age 70 years, range 49-86) with medium-low levels of trigger PSA ranging between 0.5 and 5 ng/ml (mean PSA 2.1 ng/ml); group B was chosen in order to obtain a more homogeneous group of patients in terms of PSA values also excluding both very low and very high PSA levels avoiding the "a priori" higher probability of negative or positive PET scan, respectively. At the time of examination, 139 patients from group A and 72 patients from group B were under ADT: these patients were considered to be hormone-resistant PC patients because from their oncologic history (>18 months) an increase of PSA levels emerged despite the ongoing ADT. The relationship between (18)F-CH PET/CT findings and possible clinical predictors was investigated using both univariate and multivariate binary logistic regression analyses, including trigger PSA and ADT.. Considering the whole population, overall DR of (18)F-CH PET was 58.2 % (189/325 patients). In the whole sample of patients (group A), both at the univariate and multivariate logistic regression analysis, trigger PSA and ADT were significantly correlated with the DR of (18)F-CH PET (p < 0.05). Moreover, the DR in patients under ADT (mean PSA 7.8 ng/ml) was higher than in patients not under ADT (mean PSA 3.9 ng/ml), (DR was 70.5 % and 48.9 %, respectively; p < 0.001), therefore, demonstrating the existence of a significant correlation between the DR of (18)F-CH PET and ADT. In group B patients only trigger PSA resulted a reliable predictor of the (18)F-CH positivity, since ADT was not correlated to the DR of (18)F-CH PET (p = 0.061). Also in group B the DR of (18)F-CH PET in patients under ADT was higher than in patients not under ADT (65.3 % and 51.3 %, respectively) but the difference was not significant without a statistically significant correlation in the Mann Whitney test (p = 0.456) therefore, suggesting the lack of correlation between DR (18)F-CH PET/CT and ADT.. Similarly to previous published studies, in our series the overall DR of (18)F-CH PET/CT was 58 % and was significantly correlated to trigger PSA. The most important finding of the present study is that ADT does not negatively influence DR of (18)F-CH PET/CT in PC patients with biochemical relapse; therefore, it can be suggested that it is not necessary to withdraw ADT before performing (18)F-CH PET/CT.

Topics: Aged; Aged, 80 and over; Androgens; Choline; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Retrospective Studies; Sensitivity and Specificity; 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

To retrospectively review data of a cohort of patients with biochemical progression after radical prostatectomy, treated according to a uniform institutional treatment policy, to evaluate toxicity and feasibility of high-dose salvage radiation therapy (80 Gy).. Data on 60 patients with biochemical progression after radical prostatectomy between January 2009 and September 2011 were reviewed. The median value of prostate-specific antigen before radiation therapy was 0.9 ng/mL. All patients at time of diagnosis of biochemical recurrence underwent dynamic (18)F-choline positron emission tomography/computed tomography (PET/CT), which revealed in all cases a local recurrence. High-dose salvage radiation therapy was delivered up to total dose of 80 Gy to 18F-choline PET/CT-positive area. Toxicity was recorded according to the Common Terminology Criteria for Adverse Events, version 3.0, scale.. Treatment was generally well tolerated: 54 patients (90%) completed salvage radiation therapy without any interruption. Gastrointestinal grade ≥2 acute toxicity was recorded in 6 patients (10%), whereas no patient experienced a grade ≥2 genitourinary toxicity. No grade 4 acute toxicity events were recorded. Only 1 patient (1.7%) experienced a grade 2 gastrointestinal late toxicity. With a mean follow-up of 31.2 months, 46 of 60 patients (76.6%) were free of recurrence. The 3-year biochemical progression-free survival rate was 72.5%.. At early follow-up, (18)F-choline PET/CT-driven high-dose salvage radiation therapy seems to be feasible and well tolerated, with a low rate of toxicity.

Topics: Aged; Aged, 80 and over; Choline; Disease Progression; Feasibility Studies; Fluorine Radioisotopes; Gastrointestinal Tract; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiotherapy Dosage; Radiotherapy, Image-Guided; Retrospective Studies; Salvage Therapy; Tomography, X-Ray Computed; Urogenital System

The purposes of this study were to evaluate the feasibility of simultaneous 18F choline positron emission tomography (PET) and magnetic resonance imaging (MRI) of the prostate and to present the first clinical results of the method.. From March 2012 to October 2012, a total of 15 consecutive patients were examined with simultaneous 18F choline PET/MRI. At the time of the examination, 8 patients had histologically proven prostate cancer, 2 patients had repeated prostate biopsies with negative results, and 5 patients had suspected prostate cancer with an elevated or rising prostate specific antigene level but did not have a prostate biopsy. Sequence protocol comprised T2-weighted high-resolution images and diffusion-weighted images of the prostate in addition to PET imaging. Image quality was assessed by 2 radiologists, and the PET images were evaluated qualitatively and quantitatively.. Simultaneous PET/MRI of the prostate was accomplished successfully in all patients. The method proved to be robust without technical failure, and the image quality was rated to be diagnostic in all examinations except in 1 diffusion-weighted imaging (DWI) data set that was judged to be nondiagnostic because of susceptibility artifacts. High-resolution T2-weighted images allowed exact correlation of elevated focal or diffuse choline uptake to suspicious T2-weighted lesions of the prostate. A high accordance was found between PET and DWI. However, PET-positive lesions were found in 3 patients wherein DWI did not indicate tumor in suspicious T2-weighted lesions.. Simultaneous positron emission tomography/magnetic resonance imaging of the prostate has the advantage of combining high-resolution prostate images, functional studies, and metabolic/molecular imaging. The PET component adds diagnostic confidence to the MRI-based parameters in identifying and localizing tumor in the prostate.

Topics: Aged; Choline; Feasibility Studies; Fluorine Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Observer Variation; Positron-Emission Tomography; Prostate; Prostatic Neoplasms; Reproducibility of Results

The aims of the study were (a) to evaluate the diagnostic role, by means of positive detection rate (PDR), of ¹⁸F-choline (CH) positron emission tomography (PET)/CT in patients with prostate cancer treated with radiotherapy, with curative intent, and suspicion of relapse during follow-up, (b) to correlate the PDR with trigger prostate-specific antigen (PSA), (c) to investigate the possible influence of androgen deprivation therapy (ADT) at the time of scan on PDR and (d) to assess distribution of metastatic spread.. ¹⁸F-CH PET/CT exams from 46 consecutive patients (mean age 71.3 years, range 51-84 years) with prostate cancer (mean Gleason score 6.4, range 5-8) previously treated by definitive radiotherapy and with suspicion of relapse with negative or inconclusive conventional imaging were retrospectively evaluated. Of the 46 patients, 12 were treated with brachytherapy and 34 with external beam radiation therapy. Twenty-three patients were under ADT at the time of the examination. Trigger PSA was measured within 1 month before the exam (mean value 6.5 ng/ml, range 1.1-49.4 ng/ml). Patients were subdivided into four groups according to their PSA level: 1.0 < PSA ≤ 2.0 ng/ml (11 patients), 2.0 < PSA ≤ 4.0 ng/ml (16 patients), 4.0 < PSA ≤ 6.0 ng/ml (9 patients) and PSA > 6.0 ng/ml (10 patients). Correlation between ADT and PDR was investigated as well as between PSA and distribution of metastatic spread.. The overall PDR of ¹⁸F-CH PET/CT was 80.4% (37/46 patients), increasing with the increase of trigger PSA. PDR of ¹⁸F-CH PET/CT is not influenced by ADT (p = 0.710) even if PET performed under ADT demonstrated an overall higher PDR (82.6%). The majority of the patients (59%, 22/37 patients) showed local relapse only, confined to the prostatic bed; 22% of the PET/CT-positive patients (8/37 patients) showed distant relapse only (bone localizations in all of them), while the remaining 19% (7/37 patients) showed both local and distant (lymph node and bone) spread.. ¹⁸F-CH PET/CT showed a high overall detection rate (80%), proportional to the trigger PSA (both for local and distant relapse) not influenced by ADT. ¹⁸F-CH PET/CT is proposed as a first-line imaging procedure in restaging prostate cancer patients primarily treated with radiotherapy.

Topics: Aged; Aged, 80 and over; Brachytherapy; Choline; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals; Recurrence; Tomography, X-Ray Computed

The aim of our study was to evaluate the accuracy of F-18 choline positron emission tomography/computed tomography (PET/CT) in assessing the presence of extraprostatic disease during staging of prostate cancer, in relation to prostate-specific antigen (PSA) and PSA density, a PSA derivative that is useful for improving risk stratification in prostate cancer patients.. F-18 choline PET/CT was performed in 45 patients for early staging of biopsy-proven prostate cancer. None of the examined patients had received therapy before the examination. In all of them a transrectal ultrasonography had been performed earlier to calculate the prostate volume and PSA density. The mean PSA value was 25.5 (±38.1) ng/ml, whereas the mean PSA density was 0.70 (±0.88).. Results of F-18 choline PET/CT were related to PSA and PSA density. PET/CT was positive for extraprostatic disease in 18/45 patients (40%) (mean PSA and PSA density were, respectively, 44.08 ng/ml and 1.08); PET/CT was negative for extraprostatic disease in 27/45 patients (60%) (mean PSA and PSA density were, respectively, 13.12 ng/ml and 0.4). PET/CT was positive in 13/18 patients (72%) with a PSA cutoff value greater than or equal to 18 ng/ml and in 5/21 (24%) with a PSA value less than 18 ng/ml (P=0.0017). PET/CT was positive in 16/18 patients (89%) with PSA density greater than or equal to 0.31 and in 2/18 (11%) with PSA density lower than 0.31 (P=0.0234).. The possibility of detecting extraprostatic disease of prostate cancer with F-18 choline PET/CT is related to PSA and PSA density. In particular, F-18 choline PET/CT should be recommended only in patients with a PSA value of at least 18 ng/ml, whereas a PSA density of at least 0.31 ng/ml is more probably associated with distant metastases.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Staging; Patient Selection; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Tomography, X-Ray Computed

The (18)F-choline PET-CT (FCH) has better performance in the assessment of patients with prostate cancer than (18)F-FDG. However, similarly, it is also not a tumor specific radiotracer. We present four (18)F-FCH PET-CT scans in which false positive findings were correctly assessed after evaluation with CT, clinical parameters and/or histological analysis.

Topics: Choline; False Positive Reactions; Fluorine Radioisotopes; Humans; Male; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

The aim of this study was to evaluate the efficacy of ¹⁸F-choline PET/CT (18FCH-PET/CT) in restaging patients previously treated by radical prostatectomy for a prostate cancer, presenting with biochemical relapse during follow-up (FU).. Three hundred thirty-one patients referred to us from January 2009 to April 2011 to perform 18FCH PET/CT were evaluated: 233 of them (mean age 69.7 years) met the inclusion criteria of the study: (1) biochemical relapse after radical prostatectomy (trigger PSA>0.2 ng/mL) (n=224) and (2) high risk for relapse (elevated Gleason score≥8) in spite PSA<0.1 ng/mL during FU (n=9). Trigger PSA was available for all patients (mean 8 ng/mL) and in 44 of them also PSA kinetic (PSA velocity-PSAvel; PSA doubling time-PSAdt). Correlation between 18FCH PET/CT detection rate and trigger PSA, PSAvel, PSAdt, and tumoral spread distribution were evaluated by univariate and multivariate analysis. Subsequent minimum FU was 1 year (mean 26 months, range 12-40).. Overall detection rate of 18FCH PET/CT was 54%, which significantly increased when the trigger PSA increases (P<0.001). PET-positive patients presented a "fast" PSA kinetic (mean PSAdt=6 months and mean PSAvel=9.3 ng/mL/yr), while PET-negative patients presented a "slow" PSA kinetic (mean PSAdt=15.4 months and mean PSAvel=0.9 ng/mL/yr). Disease relapse was local in 17% of cases, distant in 66%, and combined in 17%.. Overall 18FCH PET/CT detection rate was 54% (ie, similar to that reported in literature with ¹¹C-choline), which increases with the increase in trigger PSA: this condition was particularly true in patients with accelerated PSA kinetic. In about 20% of patients, 18FCH PET/CT demonstrated local relapses early enough to offer locoregional radiation therapy.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Middle Aged; Multimodal Imaging; Multivariate Analysis; Neoplasm Metastasis; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Recurrence; Tomography, X-Ray Computed

This work develops a compartmental model of (18)F-choline in order to evaluate its biokinetics and so to describe the temporal variation of the radiopharmaceuticals' uptake in and clearance from organs and tissues.. Ten patients were considered in this study. A commercially available tool for compartmental analysis (SAAM II) was used to model the values of activity concentrations in organs and tissues obtained from PET images or from measurements of collected blood and urine samples.. A linear compartmental model of the biokinetics of the radiopharmaceutical was initially developed. It features a central compartment (blood) exchanging with organs. The structure describes explicitly liver, kidneys, spleen, blood and urinary excretion. The linear model tended to overestimate systematically the activity in the liver and in the kidney compartments in the first 20 min post-administration. A nonlinear process of kinetic saturation was considered, according to the typical Michaelis-Menten kinetics. Therefore nonlinear equations were added to describe the flux of (18)F-choline from blood to liver and from blood to kidneys. The nonlinear model showed a tendency for improvement in the description of the activity in liver and kidneys, but not for the urine.. The simple linear model presented is not able to properly describe the biokinetics of (18)F-choline as measured in prostatic cancer patients. The introduction of nonlinear kinetics, although based on physiologically plausible assumptions, resulted in nonsignificant improvements of the model predictive power.

Topics: Choline; Humans; Kidney; Liver; Male; Metabolic Clearance Rate; Models, Biological; Nonlinear Dynamics; Positron-Emission Tomography; Prostatic Neoplasms; Spleen; Tissue Distribution; Tomography, X-Ray Computed; Urinary Bladder

To evaluate the accuracy of contrast-enhanced (18)F-choline PET/CT in restaging patients with prostate cancer after radical prostatectomy in relation to PSA, PSA velocity (PSAve) and PSA doubling time (PSAdt).. PET/CT was performed in 49 patients (age range 58-87 years) with rising PSA (mean 4.13 ng/ml) who were divided in four groups according to PSA level: ≤1 ng/ml, 1 to ≤2 ng/ml, 2 to ≤4 ng/ml, and >4 ng/ml. PSAve and PSAdt were measured. PET and CT scans were interpreted separately and then together.. PET/CT diagnosed relapse in 33 of the 49 patients (67%). The detection rates were 20%, 55%, 80% and 87% in the PSA groups ≤1, 1 to ≤2, 2 to ≤4 and >4 ng/ml, respectively. PET/CT was positive in 7 of 18 patients (38.9%) with a PSA ≤2 ng/ml, and in 26 of 31 (83.9%) with a PSA >2 ng/ml. PET/CT was positive in 7 of 25 patients (84%) with PSAdt ≤6 months, and in 12 of 24 patients (50%) with PSAdt >6 months, and was positive in 26 of 30 patients (86%) with a PSAve >2 ng/ml per year, and in 7 of 19 patients (36.8%) with PSAve ≤2 ng/ml per year. PET alone was positive in 31 of 49 patients (63.3%), and of these 31 patients, CT was negative in 14 but diagnosed bone lesions in 2 patients in whom PET alone was negative. CT with the administration of intravenous contrast medium did not provide any further information.. Detection rate of (18)F-choline imaging is closely related to PSA and PSA kinetics. In particular, (18)F-choline PET/CT is recommended in patients with PSA >2 ng/ml, PSAdt ≤6 months and PSAve >2 ng/ml per year. CT is useful for detecting bone metastases that are not (18)F-choline-avid. The use of intravenous contrast agent seems unnecessary.

Topics: Aged; Aged, 80 and over; Choline; Contrast Media; Humans; Kinetics; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Tomography, X-Ray Computed; Whole Body Imaging

To investigate the clinical value of (18)F-fluorocholine PET/CT (CH-PET/CT) in treatment decisions in patients with recurrent prostate cancer (rPCA).. The study was a retrospective evaluation of 156 patients with rPCA and CH-PET/CT for restaging. Questionnaires for each examination were sent to the referring physicians 14-64 months after examination. Questions included information regarding initial extent of disease, curative first-line treatment, and the treatment plan before and after CH-PET/CT. Additionally, PSA values at diagnosis, after initial treatment, before CH-PET/CT and at the end of follow-up were also obtained from the questionnaires.. Mean follow-up was 42 months. The mean Gleason score was 6.9 at initial diagnosis. Initial treatment was: radical prostatectomy in 110 patients, radiotherapy in 39, and combined prostatectomy and radiotherapy in 7. Median PSA values before CH-PET/CT and at the end of follow-up were 3.40 ng/ml and 0.91 ng/ml. PSA levels remained stable, decreased or were below measurable levels in 108 patients. PSA levels increased in 48 patients. In 75 of the 156 patients (48%) the treatment plan was changed due to the CH-PET/CT findings. In 33 patients the therapeutic plan was changed from palliative treatment to treatment with curative intent. In 15 patients treatment was changed from curative to palliative. In 8 patients treatment was changed from curative to another strategy and in 2 patients from one palliative strategy to another. In 17 patients the treatment plan was adapted.. CH-PET/CT has an important impact on the therapeutic strategy in patients with rPCA and can help to determine an appropriate treatment.

Topics: Adult; Aged; Choline; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Recurrence; Retrospective Studies; Tomography, X-Ray Computed

Study Type--Diagnostic (exploratory cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Staging of patients with prostate cancer is the cornerstone of treatment. However, after curative intended therapy a high portion of patients relapse with local and/or distant recurrence. Therefore, one may question whether surgical lymph node dissection (LND) is sufficiently reliable for staging of these patients. Several imaging methods for primary LN staging of patients with prostate cancer have been tested. Acceptable detection rates have not been achieved by CT or MRI or for that matter with PET/CT using the most common tracer fluoromethylcholine (FCH). Other more recent metabolic tracers like acetate and choline seem to be more sensitive for assessment of LNs in both primary staging and re-staging. However, previous studies were small. Therefore, we assessed the value of [(18) F]FCH PET/CT for primary LN staging in a prospective study of a larger sample and with a 'blinded' review. After a study period of 3 years and >200 included patients, we concluded that [(18) F]FCH PET/CT did not reach an optimal detection rate compared with LND, and, therefore, it cannot replace this procedure. However, we did detect several bone metastases with [(18) F]FCH PET/CT that the normal bone scans had missed, and this might be worth pursuing.. • To assess the value of [(18) F]fluoromethylcholine (FCH) positron emission tomography/computed tomography (PET/CT) for lymph node (LN) staging of prostate cancer. • To evaluate if FCH PET/CT can replace LN dissection (LND) for LN staging of prostate cancer, as about one-third of patients with prostate cancer who receive intended curative therapy will have recurrence, one reason being undetected LN involvement.. • From January 2008 to December 2010, 210 intermediate- or high-risk patients had a FCH PET/CT scan before regional LND. • After dissection, the result of histological examination of the LNs (gold standard) was compared with the result of FCH PET/CT obtained by 'blinded review'. • Sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of FCH PET/CT were measured for detection of LNe metastases.. • Of the 210 patients, 76 (36.2%) were in the intermediate-risk group and 134 (63.8%) were in the high-risk group. A medium (range) of 5 (1-28) LNs were removed per patient. • Histological examination of removed LNs showed metastases in 41 patients. Sensitivity, specificity, PPV, and NPV of FCH PET/CT for patient-based LN staging were 73.2%, 87.6%, 58.8% and 93.1%, respectively. • Corresponding values for LN-based analyses were 56.2%, 94.0%, 40.2%, and 96.8%, respectively. • The mean diameter of the true positive LN metastases was significantly larger than that of the false negative LNs (10.3 vs 4.6 mm; P < 0.001). • In addition, FCH PET/CT detected a high focal bone uptake, consistent with bone metastases, in 18 patients, 12 of which had histologically benign LNs.. • Due to a relatively low sensitivity and a correspondingly rather low PPV, FCH PET/CT is not ideal for primary LN staging in patients with prostate cancer. • However, FCH PET/CT does convey important additional information otherwise not recognised, especially for bone metastases.

Topics: Aged; Bone Neoplasms; Choline; Fluorine Radioisotopes; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prospective Studies; Prostatic Neoplasms; Sensitivity and Specificity; Tomography, X-Ray Computed

To investigate whether time-trends of enhanced [(18)F]Fluoromethylcholine ([(18)F]FCH) in lymph nodes (LN) of prostate cancer (PCa) patients can help to discriminate reactive from malignant ones, and whether single time point standardized uptake value (SUV) measurements also suffice.. 25 PCa patients with inguinal (presumed benign) and enlarged pelvic LN (presumed malignant) showing enhanced [(18)F]FCH uptake at dual-phase PET-CT were analyzed. Associations between LN status (benign versus malignant) and SUV(max) and SUV(meanA50), determined at 2 min (early) and 30 min (late) post injection, were assessed. We considered two time-trends of [(18)F]FCH uptake: type A (SUV early > SUV late) and type B (SUV late ≥ SUV early). Histopathology and/or follow-up were used to confirm the assumption that LN with type A pattern are benign, and LN with type B pattern malignant.. Analysis of 54 nodes showed that LN status, time-trends, and 'late' (30 min p.i.) SUV(max) and SUV(meanA50) parameters were strongly associated (P<0.0001). SUV(max) relative difference was the best LN status predictor. All but one inguinal LN showed a decreasing [(18)F]FCH uptake over time (pattern A), while 95% of the pelvic nodes presented a stable or increasing uptake (pattern B) type.. Time-trends of enhanced [(18)F]FCH uptake can help to characterize lymph nodes in prostate cancer patients. Single time-point SUV measurements, 30 min p.i., may be a reasonable alternative for predicting benign versus malignant status of lymph nodes, but this remains to be validated in non-enlarged pelvic lymph nodes.

Topics: Aged; Aged, 80 and over; Choline; Humans; Lymph Nodes; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; ROC Curve; Tomography, X-Ray Computed

18F-choline positron emission tomography (PET)/computed tomography (CT) is an integral part in restaging of patients with prostate cancer (PC). The aim of this study was to describe the whole-body physiologic distribution of 18F-choline and to discuss some abnormal sites of uptake not related to PC we observed.. Eighty consecutive patients submitted to 18F-choline PET/CT imaging for primary staging or biochemical recurrence (prostate specific antigen rising) after treatment of PC was considered. Whole-body PET/CT was acquired approximately 40 min after 18F-choline injection.. We observed physiological 18F-choline uptake in liver, pancreas, spleen, salivary and lachrymal glands and also, owing to renal excretion, in urinary tract. Other sites of less intense tracer uptake were bone marrow and intestines. We found abnormal and unexpected PET findings in 15 patients (18.7%), not owing to PC localizations. The majority of these findings were owing to inflammation (12 of 15); a case of low grade lymphoma was detected; two patients showed focal brain uptake of 18F-choline and were subsequently submitted to magnetic resonance: in one a meningioma and in the other a low-grade brain tumour were diagnosed.. Accurate knowledge of the biodistribution of 18F-choline is essential for the correct interpretation of PET/CT imaging. CT enables differentiation of physiological bowel activity and 18F-choline excretion in the ureters. In our series, 18F-choline uptake in benign pathological conditions mainly included sites of inflammation; nevertheless, accumulation in tumour deposits not because PC cannot be excluded, particularly in the brain, where correlative imaging with magnetic resonance is of the utmost importance.

Topics: Aged; Aged, 80 and over; Brain; Choline; Humans; Image Interpretation, Computer-Assisted; Inflammation; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Solitary Pulmonary Nodule; Tissue Distribution; Tomography, X-Ray Computed; Whole Body Imaging

Topics: Aged; Choline; Humans; Inflammation; Male; Neoplasm Metastasis; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

To report the own experience with 66 patients who received 18F-choline PET-CT (positron emission tomography-computed tomography) for treatment planning.. Image acquisition followed 1 h after injection of 178-355 MBq (18)F-choline. An intraprostatic lesion (GTV(PET) [gross tumor volume]) was defined by a tumor-to-background SUV (standard uptake value) ratio > 2. A dose of 76 Gy was prescribed to the prostate in 2-Gy fractions, with a simultaneous integrated boost up to 80 Gy.. A boost volume could not be defined for a single patient. One, two and three or more lesions were found for 36 (55%), 22 (33%) and seven patients (11%). The lobe(s) with a positive biopsy correlated with a GTV(PET) in the same lobe in 63 cases (97%). GTV(PET) was additionally defined in 33 of 41 prostate lobes (80%) with only negative biopsies. GTV(PET), SUV(mean) and SUV(max) were found to be dependent on well-known prognostic risk factors, particularly T-stage and Gleason Score. In multivariate analysis, Gleason Score > 7 resulted as an independent factor for GTV(PET) > 8 cm(3) (hazard ratio 5.5; p = 0.02) and SUV(max) > 5 (hazard ratio 4.4; p = 0.04). Neoadjuvant hormonal treatment (NHT) did not affect SUV levels. The mean EUDs (equivalent uniform doses) to the rectum and bladder (55.9 Gy and 54.8 Gy) were comparable to patients (n = 18) who were treated in the same period without a boost (54.3 Gy and 55.6 Gy).. Treatment planning with (18)F-choline PET-CT allows the definition of an integrated boost in nearly all prostate cancer patients - including patients after NHT - without considerably affecting EUDs for the organs at risk. GTV(PET) and SUV levels were found to be dependent on prognostic risk factors, particularly Gleason Score.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Biopsy; Choline; Dose Fractionation, Radiation; Humans; Male; Middle Aged; Molecular Imaging; Neoadjuvant Therapy; Neoplasm Staging; Positron-Emission Tomography; Prognosis; Prostate; Prostatic Neoplasms; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Tomography, X-Ray Computed

Choline is an essential amino acid, which is needed for the synthesis of membrane phospholipids. The choline uptake pathway is increasingly applied for molecular imaging of proliferating tumors. We describe a patient in whom we encountered an unexpected finding when he was referred for a routine [18F]-methylcholine PET/computed tomography scan to restage his prostate carcinoma. There was only visualization of circulating [18F]-methylcholine and no active uptake in any relevant organ. Owing to this abnormal biological behavior the scan was deemed uninterpretable. On checking his comorbidity and medication, the patient was found to take colchicine on a daily basis for his gout. After discontinuation of colchicine, the biodistribution of [18F]-methylcholine normalized. We present a possible explanation for these findings, with an impact on molecular imaging of the choline pathway and possibly reaching beyond colchicine alone.

Topics: Aged; Choline; Colchicine; Humans; Male; Neoplasm Staging; Positron-Emission Tomography; Prostatic Neoplasms; Tissue Distribution; Tomography, X-Ray Computed

Volumetric assessment of PET signals becomes increasingly relevant for radiotherapy (RT) planning. Here, we investigate the utility of 18F-choline PET signals to serve as a structure for semi-automatic segmentation for forward treatment planning of prostate cancer. 18F-choline PET and CT scans of ten patients with histologically proven prostate cancer without extracapsular growth were acquired using a combined PET/CT scanner. Target volumes were manually delineated on CT images using standard software. Volumes were also obtained from 18F-choline PET images using an asymmetrical segmentation algorithm. PTVs were derived from CT 18F-choline PET based clinical target volumes (CTVs) by automatic expansion and comparative planning was performed. As a read-out for dose given to non-target structures, dose to the rectal wall was assessed. Planning target volumes (PTVs) derived from CT and 18F-choline PET yielded comparable results. Optimal matching of CT and 18F-choline PET derived volumes in the lateral and cranial-caudal directions was obtained using a background-subtracted signal thresholds of 23.0+/-2.6%. In antero-posterior direction, where adaptation compensating for rectal signal overflow was required, optimal matching was achieved with a threshold of 49.5+/-4.6%. 3D-conformal planning with CT or 18F-choline PET resulted in comparable doses to the rectal wall. Choline PET signals of the prostate provide adequate spatial information amendable to standardized asymmetrical region growing algorithms for PET-based target volume definition for external beam RT.

Topics: Choline; Humans; Imaging, Three-Dimensional; Male; Positron-Emission Tomography; Prostate; Prostatic Neoplasms; Radiotherapy Planning, Computer-Assisted