F-18 fluorocholine positron emission tomography-computed tomography in initial staging and recurrence evaluation of prostate carcinoma: A prospective comparative study with diffusion-weighted magnetic resonance imaging and whole-body skeletal scintigraphy

Prostate cancer (PCa) is one of the major causes of death due to cancer in men. Conventional imaging modalities such as magnetic resonance imaging (MRI) provide locoregional status, but fall short in identifying distant metastasis. C-11 choline F-18 fluorocholine (F-18 FCH) has been shown to be useful in imaging of PCa. The present prospective study evaluates and compares the role of F-18 FCH positron emission tomography-computed tomography (PET-CT) with locoregional MRI and whole-body bone scintigraphy in PCa patients for initial staging and recurrence evaluation. This study included a total of 50 patients. Tc-99m skeletal scintigraphy, F-18 FCH PET-CT, and diffusion-weighted MRI of the pelvic region were performed within a span of 2-3 weeks of each other, in random order. For the primary site, core biopsy findings of the lesion were considered as gold standard. The kappa test was used to measure agreement between bone scintigraphy, F-18 FCH, and MRI. For comparing Tc-99m bone scintigraphy, F-18 FCH, and MRI, McNemar's test was applied. F-18 FCH PET-CT and MRI were able to detect primary lesion in all initial staging patients. The sensitivity and specificity of F-18 FCH PET-CT versus MRI were found to be 92.8% versus 89.2% and 100 versus 80%, respectively, for the recurrence at the primary site. A total of 55 bony lesions at distant sites were detected on F-18 FCH PET-CT in comparison to 43 bone lesions on whole-body bone scintigraphy. F-18 FCH PET/CT also detected additional lung lesions in 2 patients and abdominal lymph nodes in 12 patients. F-18 FCH PET-CT could detect primary lesions, local metastasis, bone metastasis, and distant metastasis in a single study and is also a useful modality in recurrence evaluation in PCa patients.