An Overview of the Potential Applications of Choline PET/CT in Prostate Cancer

Introduction and background

In the natural history of prostate cancer patients, different conventional imaging (CI) modalities can be used: transrectal ultrasound (TRUS) with or without biopsy, magnetic resonance (MR), computerized tomography (CT), and bone scintigraphy (BS). However, the CIs have several limitations: TRUS showed low sensitivity in the diagnosis of local disease; MR with endo-rectal coil and spectroscopy gave promising results in the localization of cancer, but this method is not aimed to guide biopsy and moreover is affected by low accuracy if performed early after the TRUS biopsy; CT scan showed a low accuracy in the detection of lymph nodes metastasis, which are presumed to be positive on the nomograms basis; finally TRUS, BS, CT, MR showed very low sensitivity in the detection of the site of relapse after radical prostatectomy (RP) or radiation therapy (RT) in the case of biochemical recurrence. That is why in all the steps of the natural history of prostate cancer there is need for a new imaging methods to increase the accuracy in the detection of disease.

Abstract

The aim of this review is to offer an overview about the potential applications of choline PET/CT in prostate cancer patients. The potential use of molecular imaging in the field of prostate cancer comes from the lack of accuracy of conventional imaging methods such as a CT, MR, or bone scan. It is a known fact that conventional imaging methods gives poor results either in cancer detection, stage, or restage of the disease in the case of biochemical recurrence. Choline PET/CT has been used in all steps of the natural history of the disease; however, it can be summarized that the most important application of choline PET/CT is represented by the restaging of the disease in the case of biochemical relapse. A main advantage of PET/CT is the detection of lymph node metastasis and small initial bone metastases. In particular, choline PET/CT could play a crucial role as a first diagnostic procedure in prostate cancer patients who show fast PSA kinetics.

Keywords

prostate cancer, choline PET/CT, review