18F‐Fluorocholine PET/CT in prostate cancer initial staging


  • Paula Lapa Serviço de Medicina Nuclear, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Rodolfo Silva Serviço de Medicina Nuclear, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Tiago Saraiva Serviço de Medicina Nuclear, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Arnaldo Figueiredo Serviço de Urologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Rui Ferreira Serviço de Medicina Nuclear, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Gracinda Costa Serviço de Medicina Nuclear, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • João Pedroso Lima Serviço de Medicina Nuclear, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal




Fluorocholine, Prostatic Neoplasms, Radiopharmaceuticals, Positron‐Emission Tomography


In the evaluation of prostate cancer, clinical nomograms are commonly used to predict the probability of lymphatic and extra‐nodal spread. Those nomograms may suggest the presence and the extension of this cancer but do not allow a clear distinction between loco‐regional and distant disease. In this study, it was intended to evaluate the usefulness of 18F‐Fluorocoline positron emission tomography/computed tomography (18F‐FCH‐PET/CT) in the workup of patients with the initial diagnosis of prostate cancer and staged by this imaging technique.
Material and methods
The medical records of 39 patients with prostate cancer who underwent 18F‐FCH PET/CT for initial staging, between November 2010 and April 2015, were reviewed. Of these, 20 patients were excluded because they had already started hormonotherapy. In the other 19 patients, the performance of 18F‐FCH PET/CT for the detection of lymph node metastasis was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Six patients had performed pelvic lymphadenectomy (total of 69 lymph nodes), allowing histological confirmation. When there was no histological confirmation (total of 30 lymph nodes and 3 cases of bone metastasis), the findings of 18F‐FCH PET/CT were correlated with the values of PSA and the information from multiple imaging modalities such as CT, bone scan, magnetic resonance (MRI), 18F‐Sodium Fluoride (18F‐NaF) PET/CT of control.
The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for lymph node metastasis detection were, respectively, 96.8%, 80.9%, 69.8%, 98.2% and 85.8%. In our sample, this technique also allowed the identification of nodal extra pelvic or bone metastasis in 5 patients (26.3%) with implications in the treatment. It showed uptake suggestive of bone metastasis, corroborated by other diagnostic technics or by the follow‐up, in 3 patients, those with prostate specific antigen (PSA) of 9.5±2.9 ng/mL.
18F‐FCH PET/CT is an entire body and multi organ imaging modality that allows the identification, globally, of the sites of disease in patients with prostate cancer. In this study, 18F‐FCH PET/CT showed good results when used in the initial staging of these patients. It is highlighted the ability to detect distant disease, in particular bone metastasis, even with PSA<20ng/mL.


Download data is not yet available.


1. Picchio M, Mapelli P, Panebianco V, Castellucci P, Incerti E, Briganti A, et al. Imaging biomarkers in prostate cancer: Role of PET/CT and MRI. Eur J Nucl Med Mol Imaging. 2015;42(4):644-55.

2. Kent C. Regulation of phosphatidylcholine biosynthesis. Prog Lipid Res. 1990;29(2):87-105.

3. Fox JJ, Schöder H, Larson SM. Molecular imaging of prostate cancer. Curr Opin Urol. 2012;22(4):320-7.

4. Ceci F, Castellucci P, Graziani T, Schiavina R, Brunocilla E, Mazzarotto R, et al. 11C-choline PET/CT detects the site of relapse in the majority of prostate cancer patients showing biochemical recurrence after EBRT. Eur J Nucl Med Mol Imaging. 2014;41(5):878-86.

5. Kwee SA, Coel MN, Lim J, Ko JP. Prostate cancer localization with 18fluorine fluorocholine positron emission tomography. J Urol. 2005;173(1):252-5.

6. Farsad M, Schwarzenböck S, Krause BJ. PET/CT and choline: Diagnosis and staging. Q J Nucl Med Mol Imaging.

7. Xie W, Tan AE, Cheng C, Whatt AG. Occult prostate cancer detected with 18F-fluorocholine positron emission
tomography/computed tomography. World J Nucl Med. 2014;13(3):205-8.

8. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65(1):124-37.

9. Abern MR, Terris MK, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, et al. The impact of pathologic staging on the long-term oncologic outcomes of patients with clinically high-risk prostate cancer. Cancer. 2014;120(11):1656-62.

10. Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: The essential importance of percentage of positive cores. Eur Urol. 2012;61(3):480-7.

11. Abuzallouf S, Dayes I, Lukka H. Baseline staging of newly diagnosed prostate cancer: A summary of the literature. J Urol. 2014;171:2122-7.

12. Hricak H, Choyke P, Eberhardt S, Leibel S, Scardino P. Imaging prostate cancer: A multidisciplinary prespective. Radiology. 2007;243:28-53.

13. Murphy G, Haider M, Ghai S, Sreeharsha B. The expanding role of MRI in prostate cancer. AJR Am J Roentgenol. 2013;201(6):1229-38.

14. Heesakkers RA, Hövels AM, Jager GJ, van den Bosch HC, Witjes JA, Raat HP, et al. MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: A prospective multicohort study. Lancet Oncol. 2008;9(9):850-6.

15. Kitajima K, Murphy RC, Nathan MA, Froemming AT, Hagen CE, Takahashi N, et al. Detection of recurrent prostate cancer after radical prostatectomy: Comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil. J Nucl Med. 2014;55(2):223-32.

16. Brenot-Rossi I. Focus: Prostate cancer and PET-choline. Prog Urol. 2014;24(1):3-8.

17. Gandaglia G, Abdollah F, Schiffmann J, Trudeau V, Shariat SF, Kim SP, et al. Distribution of metastatic sites in patients with prostate cancer: A population-based analysis. Prostate. 2014;74(2):210-6.

18. McMurtry CT, McMurtry JM. Metastatic prostate cancer: Complications and treatment. J Am Geriatr Soc.

19. Poulsen MH, Petersen H, Høilund-Carlsen PF, Jakobsen JS, Gerke O, Karstoft J, et al. Spine metastases in prostate cancer: Comparison of technetium-99m-MDP whole-body bone scintigraphy, [(18) F]choline positron emission tomography(PET)/computed tomography (CT) and [(18) F]NaF PET/CT. BJU Int. 2014;114(6):818-23.

20. Wondergem M, van der Zant FM, van der Ploeg T, Knol RJ. A literature review of 18F-fluoride PET/CT and 18F-choline or 11C-choline PET/CT for detection of bone metastases in patients with prostate cancer. Nucl Med Commun. 2013;34(10):935-45.

21. Vali R, Loidl W, Pirich C, Langesteger W, Beheshti M. Imaging of prostate cancer with PET/CT using (18)F-Fluorocholine. Am J Nucl Med Mol Imaging. 2015;5(2):96-108.

22. Cimitan M, Bortolus R, Morassut S, Canzonieri V, Garbeglio A, Baresic T, et al. [18F]fluorocholine PET/CT imaging for the detection of recurrent cancer at PSA relapse: Experience in 100 consecutive patients. Eur J Nucl Med Mol Imaging. 2006;33:1387-98.

23. Schmid DT, John H, Zweifel R, Cservenyak T, Westera G, Goerres GW, et al. Fluorocholine PET/CT in patients with prostate cancer: Initial experience. Radiology. 2005;235:623-8.

24. Beheshti M, Imamovic L, Broinger G, Vali R, Waldenberger P, Stoiber F, et al. [18F]choline PET/CT in the preoperative staging of prostate cancer in patients with intermediate or high risk of extracapsular disease: A prospective study of 130 patients. Radiology. 2010;254:925-33.

25. Vargas HA, Grimm J, F Donati O, Sala E, Hricak H. Molecular imaging of prostate cancer: Translating molecular
biology approaches into the clinical realm. Eur Radiol. 2015;25(5):1294-302.

26. Jadvar H, Desai B, Ji L, Conti PS, Dorff TB, Groshen SG, et al. Baseline 18F-FDG PET/CT parameters as imaging biomarkers of overall survival in castrate-resistant metastatic prostate cancer. J Nucl Med. 2013;54(8):1195-201.

27. Bouchelouche K, Turkbey B, Choyke PL. Advances in imaging modalities in prostate cancer. Curr Opin Oncol.

28. Sankineni S, Brown AM, Fascelli M, Law YM, Pinto PA, Choyke PL, et al. Lymph node staging in prostate cancer. Curr Urol Rep. 2015;16(5):30.

29. Sharma S. Imaging and intervention in prostate cancer: Current perspectives and future trends. Indian J Radiol Imaging. 2014;24(2):139-48.

30. Lecouvet FE, Lhommel R, Pasoglou V, Larbi A, Jamar F, Tombal B. Novel imaging techniques reshape the landscape in high-risk prostate cancers. Curr Opin Urol. 2013;23(4):323-30.

31. Evangelista L, Cimitan M, Zattoni F, Guttilla A, Saladini G. Comparison between conventional imaging (abdominal-pelvic computed tomography and bone scan) and [(18)F]choline positron emission tomography/computed tomography imaging for the initial staging of patients with intermediate- to high-
-risk prostate cancer: A retrospective analysis. Scand J Urol. 2015:1-9.

32. Abuzallouf S, Dayes I, Lukka H. Baseline staging of newly diagnosed prostate cancer: A summary of the literature. J Urol. 2004;171 6 Pt 1:2122-7.

33. Schiavina R, Scattoni V, Castellucci P, Picchio M, Corti B, Briganti A, et al. 11C-choline positron emission tomography/ computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: Comparison with clinical staging nomograms. Eur Urol. 2008;54(2):392-401.

34. De Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJ. Preoperative staging of pelvic lymph nodes in prostate cancer by 11C-choline PET. J Nucl Med. 2003;44(3):331-5.

35. Poulsen MH, Bouchelouche K, Gerke O, Petersen H, Svolgaard B, Marcussen N, et al. [18F]-fluorocholine positron-emission/computed tomography for lymph node staging of patients with prostate cancer: Preliminary results of a prospective study. BJU Int. 2010;106(5):639-43, discussion 44.

36. Beheshti M, Vali R, Waldenberger P, Fitz F, Nader M, Loidl W, et al. Detection of bone metastases in patients with prostate cancer by 18F fluorocholine and 18F fluoride PET-CT: A comparative study. Eur J Nucl Med Mol Imaging. 2008;35(10):1766-74.

37. McCarthy M, Siew T, Campbell A, Lenzo N, Spry N, Vivian J, et al. 18F-Fluoromethylcholine (FCH) PET imaging in patients with castration-resistant prostate cancer: Prospective comparison with standard imaging. Eur J Nucl Med Mol Imaging. 2011;38(1):14-22.

38. Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid 68Ga-PSMA-ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015.

39. Kim YI, Cheon GJ, Paeng JC, Cho JY, Kwak C, Kang KW, et al. Usefulness of MRI-assisted metabolic volumetric parameters provided by simultaneous (18)F-fluorocholine PET/MRI for primary prostate cancer characterization. Eur J Nucl Med Mol Imaging. 2015.

40. Eiber M, Nekolla SG, Maurer T, Weirich G, Wester HJ, Schwaiger M. (68)Ga-PSMA PET/MR with multimodality image analysis for primary prostate cancer. Abdom Imaging. 2014.





Original Article