Prostate cancer localization with 18fluorine fluorocholine positron emission tomography

Purpose: We evaluated positron emission tomography (PET) with 18 fluorine fluorocholine (F-18 FCH) for the pretreatment localization of prostate cancer. Materials and Methods: A total of 17 patients with prostate cancer who had not yet received treatment for the disease underwent whole body PET following intravenous administration of 3.3 to 4 MBq/kg F-18 FCH. PET findings were compared with the results of prostate sextant biopsy and other imaging studies, and the clinical course. Tracer uptake in prostate sextants was measured as a maximum standardized uptake value (SUVmax) and evaluated as a predictor of the prostate sextant biopsy result by ROC analysis. Results: Prostate sextants positive for malignancy on biopsy demonstrated significantly higher SLTVmax than biopsy negative sextants (mean 5.5 vs 3.3, p <0.001). In all 6 cases in which biopsy identified malignancy on only 1 side of the prostate it was possible to identify correctly the affected side based on higher SUVmax. Area under the ROC curve for SUVmax as a discriminator of biopsy positive sextants was 0.86. In 2 patients PET demonstrated areas of abnormal uptake in the retroperitoneum. Computerized tomography confirmed the presence of retroperitoneal lymphadenopathy in these areas. In the 2 patients these lesions regressed following hormonal treatment for prostate cancer. Conclusions: Malignant tumors in the prostate gland can be localized based on a standardized regional measurement of F-18 FCH uptake. PET with F-18 FCH is potentially useful for staging and localizing prostate cancer.