Gregor Stuber MD, Abstract Co-Author: Nothing to Disclose

Norbert Manfred Blumstein, Abstract Co-Author: Nothing to Disclose

Andrik J Aschoff MD, Abstract Co-Author: Nothing to Disclose

Sven Perner, Abstract Co-Author: Nothing to Disclose

Hans-Juergen Brambs, Abstract Co-Author: Nothing to Disclose

Andrea S. Bossert MD, Presenter: Nothing to Disclose

Sven N Reske MD, Abstract Co-Author: Nothing to Disclose

Andreas K. Buck MD, Abstract Co-Author: Nothing to Disclose

Hans Werner Gottfried, Abstract Co-Author: Nothing to Disclose

Peter Messer, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Prostate cancer (PCa) is one of the most common neoplasm in males in well-developed countries. Disease staging and restaging is currently based on the combination of a series of different examinations such as CT, TRUS,MR and bone scan. For a combined assessment of the primary tumor or local relapse as well as lymph nodes and bone metastasis a new radiotracer, 11 C-Choline, was developed based on the pathophysiological mechanism of an increased choline kinase in malignant prostate tissue. Aim of this study was to identify potential pitfalls using whole body 11C-choline PET/CT for staging and restaging PCa patients (pts).

In prospective and retrospective trials (04/2002 – 04/2005) a total of 1174 pts. with histologically proven PCa were examined using contrast enhanced 11C-choline PET/CT (CPC) from the base of the skull to the prox. femora. This was part of staging or restaging and supported therapy decisions. Results of CPC were confirmed by histology findings in pts. undergoing surgery; or fine needle biopsy, other imaging modalities (CT, MRI, TRUS, US, bone scan) or PSA follow-up. Potential pitfalls and limitations of CPC were identified by comparing PET/CT findings with the above-mentioned methods.

540 pts. were scanned for primary staging (group I); 634 for restaging (group II). Group I pts. were treated primarily by surgery (91/540), brachytherapy (42/540), conformal radiotherapy (RT) (156/540) or systemic therapy (261/540). Group II pts. were examined because of a rising PSA, 412/634 after surgery, 13/634 after brachytherapy, 52/634 after RT, 157/634 after systemic therapy. In 7/1174 an increased 11C-choline uptake correlated with secondary neoplasm (true positive). In 67/1174 no focal choline uptake was detected besides rising PSA. In 8/1174 benign tumors, in 3/1174 with inflammation and in 21/1174 no reason for increased uptake could be identified (all false positive), resulting in a specificity of 91.6%.

11C-choline PET/CT is a useful tool for detecting prostate cancer in staging and restaging procedure with a favourable specificity of 91.6 %. However, some pitfalls and limitations must to be noticed.

Stuber, G, Blumstein, N, Aschoff, A, Perner, S, Brambs, H, Bossert, A, Reske, S, Buck, A, Gottfried, H, Messer, P, et al, , 11C-Choline PET/CT Imaging in Patients with Prostate Cancer: Pitfalls and Limitations.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4415224.html