Choline PET/CT Skull Base to Mid-Thigh Although choline PET has been extensively used and studied, with several large meta-analyses available [44,45], the literature is less rigorous for this specific application. There are multiple studies showing its utility in this application [136-139], with no evidence that choline PET has any detriment in performance, and given that metastatic disease outside the pelvis is increased in frequency in this setting and that choline PET activity correlates well with disease activity, it likely is of increased utility for monitoring response to treatment, although there is insufficient data. There is some evidence that ADT decreases choline uptake in lesions that are not CRPC and that it is able to predict treatment response to various agents in the setting of CRPC. Choline requires an on- site cyclotron for generation of the agent because of its short half-life, which restricts where it is feasible to perform. Post-Treatment Follow-up of Prostate Cancer Choline PET/MRI Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/MRI for follow-up of a patient treated by systemic therapy. Fluoride PET/CT Skull Base to Mid-Thigh Fluoride is a tracer that has been available for clinical use for several decades, and it aims to demonstrate the increased uptake within foci in the bone with increased bone turnover in biologic processes such as metastatic involvement, fracture, or degenerative changes. Fluoride PET has a similar mechanism with bone scan; however, it is a much more sensitive imaging agent, and it offers tomographic evalaution. A recent meta-analysis revealed fluoride PET has a much higher sensitivity compared to bone scan (96% versus 86%) [140]. Another meta- analysis compared fluoride with bone scan and whole body MRI.
Post Treatment Follow up of Prostate Cancer. Choline PET/CT Skull Base to Mid-Thigh Although choline PET has been extensively used and studied, with several large meta-analyses available [44,45], the literature is less rigorous for this specific application. There are multiple studies showing its utility in this application [136-139], with no evidence that choline PET has any detriment in performance, and given that metastatic disease outside the pelvis is increased in frequency in this setting and that choline PET activity correlates well with disease activity, it likely is of increased utility for monitoring response to treatment, although there is insufficient data. There is some evidence that ADT decreases choline uptake in lesions that are not CRPC and that it is able to predict treatment response to various agents in the setting of CRPC. Choline requires an on- site cyclotron for generation of the agent because of its short half-life, which restricts where it is feasible to perform. Post-Treatment Follow-up of Prostate Cancer Choline PET/MRI Skull Base to Mid-Thigh There is limited evidence to support the use of choline PET/MRI for follow-up of a patient treated by systemic therapy. Fluoride PET/CT Skull Base to Mid-Thigh Fluoride is a tracer that has been available for clinical use for several decades, and it aims to demonstrate the increased uptake within foci in the bone with increased bone turnover in biologic processes such as metastatic involvement, fracture, or degenerative changes. Fluoride PET has a similar mechanism with bone scan; however, it is a much more sensitive imaging agent, and it offers tomographic evalaution. A recent meta-analysis revealed fluoride PET has a much higher sensitivity compared to bone scan (96% versus 86%) [140]. Another meta- analysis compared fluoride with bone scan and whole body MRI.