¹¹C-Choline Positron Emission Tomography in Prostate Cancer: Primary Staging and Recurrent Site Staging

Objectives: To evaluate the usefulness of ¹¹C-choline positron emission tomography (PET) for primary staging and re-staging of prostate cancer. Patients and Methods:¹¹C-choline PET, a total of 22 scans, was performed on 13 patients with histologically proven prostate cancer in primary staging (n = 6) and recurrent site staging; following radical prostatectomy (n = 5) and following radiation therapy (n = 3). In 1 patient, ¹¹C-choline PET was performed in both primary staging and re-staging. Also, 3 patients histologically proven to have no malignant prostate were included. Results: Because urinary ¹¹C-choline activity was low, it did not interfere with the visualization of pelvic structures. ¹¹C-choline PET visualized normal prostate with a mean SUV of 2.99 (range 2.27–3.68) and primary prostate cancer as a hot spot in 5/6 scans with a mean SUV of 4.21 (range 2.99–6.2). In re-staging,¹¹C-choline PET was true positive in 9/16 scans and true negative in 2/16 scans. 5/16 scans in 2 patients were false negative with negative conventional imaging. Conclusions: In primary staging, ¹¹C-choline PET may not be of use because of no reliable differential ¹¹C-choline uptake of BPH and prostate cancer. On the other hand, ¹¹C-choline PET may be of value in recurrent site staging and monitoring for the prostate cancer.