Molecular imaging in prostate cancer: [11C]choline PET/CT

In recent years, positron emission tomography/computed tomography (PET/CT) with [11C]Choline has been increasingly used for the evaluation of prostate cancer. In vitro and in vivo magnetic resonance spectroscopy studies have shown increased choline compounds and over-expression of choline kinase in prostate cancer. Liver and kidney are the major sites for choline oxidation, while negligible activity is present in the bladder, representing a significant advantage for prostate imaging. In patients with prostate cancer, [11C]Choline has limited sensitivity and specificity for distinguishing malignant vs. benign prostate cells. There is no significant association between prostate [11C]Choline uptake and PSA levels, Gleason score and pathological stage, while anti-androgenic therapy interferes with the uptake of the tracer. The reduction of prostate [11C]Choline uptake following anti-androgenic hormonal therapy indicates that PET/CT with [11C]Choline could be used to monitor the response to treatment. The accuracy of the technique for lymph node staging has to be further investigated. There is good agreement among several centres on the utility of PET/CT with [11C]Choline for the detection of recurrence of disease after radical prostatectomy in patients with biochemical failure. The percent of positive scans increased with increasing PSA values, being this technique clinically valuable for restaging prostate cancer patients even with low PSA levels. Clinical guidelines to proper indicate a PET/CT with [11C]Choline study in prostatectomized patients will be defined. © 2009 Nova Science Publishers, Inc. All rights reserved