The value of 18F-Choline PET/CT in patients with elevated PSA-level and negative prostate needle biopsy for localisation of prostate cancer

Purpose Patients with persistent elevated PSA and repeated negative prostate biopsy, that means having the prostate biopsied at multiple times, were investigated with 18F-choline PET/CT to delineate prostate cancer and guide renewed prostate biopsy. Methods Twenty patients with elevated PSA and nega...

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Bibliographic Details
Published in:European journal of nuclear medicine and molecular imaging 2008-05, Vol.35 (5), p.976-983
Main Authors: Igerc, I., Kohlfürst, S., Gallowitsch, H. J., Matschnig, S., Kresnik, E., Gomez-Segovia, I., Lind, P.
Format: Article
Language:English
Subjects:
Aged
Biopsy
Biopsy, Needle
Cardiology
Choline - analogs & derivatives
False Negative Reactions
Humans
Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Nuclear Medicine
Oncology
Original Article
Orthopedics
Positron-Emission Tomography - methods
Prostate cancer
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood
Prostatic Neoplasms - diagnosis
Radiology
Radiopharmaceuticals
Reproducibility of Results
Sensitivity and Specificity
Tomography
Tomography, X-Ray Computed - methods
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Summary:Purpose Patients with persistent elevated PSA and repeated negative prostate biopsy, that means having the prostate biopsied at multiple times, were investigated with 18F-choline PET/CT to delineate prostate cancer and guide renewed prostate biopsy. Methods Twenty patients with elevated PSA and negative prostate biopsies underwent 18F-choline PET/CT. We performed an early examination of the pelvic region 3-5 min after application. After 30 minutes a whole body PET/CT examination was performed. Image analysis was performed visually and by semi-quantitative analysis calculating the maximum standardised uptake value (SUVmax). 18F-choline uptake was defined as focal, multifocal or inhomogeneous. After the 18F-choline PET/CT, all patients underwent a repeated prostate biopsy, and in the cases where a focal or multifocal uptake was found, the biopsy was guided by the result of the examination. Results Qualitative image analysis revealed focal 18F-choline uptake in 13 out of 20 patients. In five patients, prostate cancer was revealed by repeated aspiration biopsy. None of the patients with a multifocal or inhomogeneous 18F-choline uptake had a malignant neoplasm in the prostate. Semiquantitative analysis performed with SUVmax was not helpful in the discrimination of malignancy but showed high values also in benign prostate diseases, as well as in normal prostate tissue. The dual-phase protocol delivered no clear benefit in discriminating malignancy from benign alterations. Conclusion The use of 18F-choline cannot be generally recommended for localising prostate cancer; however, in highly selected patients, we found useful additional information. In 25% of patients, 18F-choline PET/CT allowed the identification of neoplastic prostatic zones.
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-007-0686-9