Imaging of prostate cancer with PET/CT using (18)F-Fluorocholine

Abstract

While (18)F-Fluorodeoxyglucose ((18)F-FDG) Positron-Emission Tomography (PET) has limited value in prostate cancer (PCa), it may be useful for specific subgroups of PCa patients with hormone-resistant poorly differentiated cell types. (18)F-Fluorocholine ((18)F-FCH) PET/CT has been increasingly used in primary and recurrent PCa and has been shown to add valuable information. Although there is a correlation between the foci of activity and the areas of malignancy in the prostate gland, the clinical value of (18)F-FCH is still controversial for detection of the malignant focus in the prostate. For the T-staging of PCa at diagnosis the value of (18)F-FCH is limited. This is probably due to limited resolution of PET system and positive findings in benign prostate diseases. Conversely, (18)F-FCH PET/CT is a promising imaging modality for the delineation of local and distant nodal recurrence and bone metastases and is poised to have an impact on therapy management. In this review, recent studies of (18)F-FCH PET/CT in PCa are summarized.

Keywords: 18F-Fluorocholine; PET/CT; Prostate cancer.

Figure 1

¹⁸F-FCH PET/CT in a 58-year-old prostate cancer patient, Gleason score 7, PSA 22.3 ng/mL, increasing PSA under anti-androgen treatment after prostatectomy and radiotherapy (biochemical recurrence). A: ¹⁸F-FCH PET MIP. B: Transaxial PET (upper row), CT (middle row) and PET/CT fusion (lower row). Mildly increased tracer uptake is visible in the left hilum arrow, SUVmax: 3.8)-suggestive of reactive lymph nodes verified as benign lesion in the follow-up clinical and imaging evaluation.

Figure 2

¹⁸F-FCH PET/CT staging in a 67-year-old prostate cancer patient, Gleason score 7, PSA 22.7 ng/mL [15]. A: Histopathology results: prostate adenocarcinoma in both lobes (marked). B: ¹⁸F-FCH PET/CT: left: transaxial PET image, right: transaxial PET/CT fusion image. ¹⁸F-FCH PET shows focal tracer uptake (SUVmax: 6.5) in both prostate lobes that correlate with histopathology findings (yellow arrow).

Figure 3

¹⁸F-FCH PET/CT staging in a 67-year-old prostate cancer patient, Gleason score 7, PSA 21.1 ng/mL. left: transaxial CT, middle: transaxial PET image, right: transaxial PET/CT fusion image. ¹⁸F-FCH PET/CT shows markedly increased tracer uptake (SUVmax: 5.3) in a small lymph node in the left internal iliac chain (arrows), verified as lymph node metastasis by histopathology [15].

Figure 4

¹⁸F-FCH PET/CT in a 58-year-old prostate cancer patient, Gleason score 7, PSA 22.3 ng/mL, with increasing PSA under anti androgen treatment after prostatectomy and radiotherapy (Biochemical recurrence) [15]. A: ¹⁸F-FCH PET MIP. B: Transaxial PET (upper row), CT (middle row) and PET/CT fusion (lower row). Focally-increased tracer uptake in the prostate bed (arrow, SUVmax: 6.5) is suggestive of local recurrence verified in the clinical and imaging follow-up. C: Transaxial PET (upper row), CT (middle row) and PET/CT fusion (lower row). Focally-increased tracer uptake in a small right external iliac chain (yellow arrow, SUVmax: 10.8), proved as lymph node metastasis in the clinical and imaging follow-up. Incidental focal tracer accumulation is noticed in the left ureter (blue arrow) [47].

Figure 5

¹⁸F-FCH PET/CT: generalized bone metastases in the skeleton in a 74-year-old prostate cancer patient, Gleason score 9, PSA 53.22 ng/mL, status post radiotherapy to the prostate, regional lymph nodes, and lumbar spine with continued anti-androgen blockade. Planning for radionuclide treatment with ²²³radium.