The Sensitivity of [11C]Choline PET/CT to Localize Prostate Cancer Depends on the Tumor Configuration

Purpose: To evaluate the dependency of the sensitivity of [11C]choline positron emission tomography/computed tomography (PET/CT) for detecting and localizing primary prostate cancer (PCa) on tumor configuration in the histologic specimen. Experimental Design: Forty-three patients with biopsy-proven PCa were included. They underwent radical prostatectomy within 31 days after [11C]choline PET/CT. The transaxial image slices and the histologic specimens were analyzed by comparing the respective slices. Maximum standardized uptake values (SUVmax) were calculated in each segment and correlated with histopathology. The tumor configuration in the histologic specimen was grouped as: I, unifocal; II, multifocal; III, rind-like shaped; IV, size <5 mm. Data analysis included the investigation of detection of PCa by SUVmax, the assessment of the influence of potential contributing factors on tumor prediction, and the evaluation of whether SUV could discriminate cancer tissue from benign prostate hyperplasia (BPH), prostatitis, HGPIN (high-grade prostate intraepithelial neoplasm), or normal prostate tissue. General estimation equation models were used for statistical analysis. Results: Tumor configuration in histology was classified as I in 21 patients, as II in 9, as III in 5, and as IV in 8. The prostate segment involved by cancer is identified in 79% of the patients. SUVmax was located in the same side of the prostate in 95% of patients. Tumor configuration was the only factor significantly negatively influencing tumor prediction (P < 0.001). PCa-SUVmax (median SUVmax = 4.9) was not significantly different from BPH-SUV (median SUVmax = 4.5) and prostatitis-SUV (median SUVmax = 3.9), P = 0.102 and P = 0.054, respectively. Conclusions: The detection and localization of PCa in the prostate with [11C]choline PET/CT is impaired by tumor configuration. Additionally, in our patient population, PCa tissue could not be distinguished from benign pathologies in the prostate. Clin Cancer Res; 17(11); 3751–9. ©2011 AACR.

[1]  A. Jemal,et al.  Cancer Statistics, 2009 , 2009, CA: a cancer journal for clinicians.

[2]  M. Picchio,et al.  PET-CT for treatment planning in prostate cancer. , 2009, The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of....

[3]  Byung Kwan Park,et al.  Update of Prostate Magnetic Resonance Imaging at 3 T , 2008, Journal of computer assisted tomography.

[4]  V. Bettinardi,et al.  [11C]Choline uptake with PET/CT for the initial diagnosis of prostate cancer: relation to PSA levels, tumour stage and anti-androgenic therapy , 2008, European Journal of Nuclear Medicine and Molecular Imaging.

[5]  J. Kurhanewicz,et al.  Prostate cancer: sextant localization with MR imaging, MR spectroscopy, and 11C-choline PET/CT. , 2007, Radiology.

[6]  Peter L Choyke,et al.  Imaging prostate cancer: a multidisciplinary perspective. , 2007, Radiology.

[7]  Robert A Smith,et al.  Cancer Screening in the United States, 2007: A Review of Current Guidelines, Practices, and Prospects , 2007, CA: a cancer journal for clinicians.

[8]  S. Fanti,et al.  11C-choline positron emission tomography/computerized tomography for tumor localization of primary prostate cancer in comparison with 12-core biopsy. , 2006, The Journal of urology.

[9]  Sven Perner,et al.  Imaging prostate cancer with 11C-choline PET/CT. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[10]  E. Rummeny,et al.  Adenocarcinomas of esophagogastric junction: multi-detector row CT to evaluate early response to neoadjuvant chemotherapy. , 2006, Radiology.

[11]  Mario Marengo,et al.  Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[12]  G. V. von Schulthess,et al.  Fluorocholine PET/CT in patients with prostate cancer: initial experience. , 2005, Radiology.

[13]  Takako Yamaguchi,et al.  Prostate cancer: a comparative study of 11C-choline PET and MR imaging combined with proton MR spectroscopy , 2005, European Journal of Nuclear Medicine and Molecular Imaging.

[14]  J. Pruim,et al.  In vivo uptake of [11C]choline does not correlate with cell proliferation in human prostate cancer , 2005, European Journal of Nuclear Medicine and Molecular Imaging.

[15]  P. Carroll,et al.  Organ-confined prostate cancer: effect of prior transrectal biopsy on endorectal MRI and MR spectroscopic imaging. , 2004, AJR. American journal of roentgenology.

[16]  H. Minn,et al.  Kinetics of [11C]choline uptake in prostate cancer: a PET stydy , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[17]  R. Rosell,et al.  Overexpression of choline kinase is a frequent feature in human tumor-derived cell lines and in lung, prostate, and colorectal human cancers. , 2002, Biochemical and biophysical research communications.

[18]  J. Nelson,et al.  Detection of increased choline compounds with proton nuclear magnetic resonance spectroscopy subsequent to malignant transformation of human prostatic epithelial cells. , 2001, Cancer research.

[19]  J Kurhanewicz,et al.  Sextant localization of prostate cancer: comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology. , 2000, The Journal of urology.

[20]  A. Bogni,et al.  [11C]Methylation on a C18 Sep-Pak cartridge: a convenient way to produce [N-methyl-11C]choline , 2000 .

[21]  N. Sadato,et al.  The increased accumulation of [18F]fluorodeoxyglucose in untreated prostate cancer. , 1999, Japanese journal of clinical oncology.

[22]  W. Fair,et al.  Incidence and clinical significance of false-negative sextant prostate biopsies. , 1998 .

[23]  M. van der Graaf,et al.  In vivo proton MR spectroscopy reveals altered metabolite content in malignant prostate tissue. , 1997, Anticancer research.

[24]  A. Heerschap,et al.  Characterization of human prostate cancer, benign prostatic hyperplasia and normal prostate by in vitro 1H and 31P magnetic resonance spectroscopy. , 1993, The Journal of urology.

[25]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[26]  E. Glatstein,et al.  Imaging Prostate Cancer with 11C-Choline PET/CT , 2008 .

[27]  M Schwaiger,et al.  PET/CT Biograph Sensation 16. Performance improvement using faster electronics. , 2006, Nuklearmedizin. Nuclear medicine.

[28]  M. Coel,et al.  Prostate cancer localization with 18fluorine fluorocholine positron emission tomography. , 2005, The Journal of urology.

[29]  H. Minn,et al.  Kinetics of [(11)C]choline uptake in prostate cancer: a PET study. , 2004, European journal of nuclear medicine and molecular imaging.

[30]  Z. Bhujwalla,et al.  Malignant transformation alters membrane choline phospholipid metabolism of human mammary epithelial cells. , 1999, Cancer research.

[31]  N. Dubrawsky.  Cancer statistics , 2022 .