Choline PET/CT Skull Base to Mid-Thigh PET with newer prostate-specific radiotracers has shown excellent performance and great potential for revolutionizing the diagnosis and, consequently, the management of patients with BCR. Choline was the first to receive FDA approval and has been extensively used and studied with several large recent meta-analyses availalable [44,45]. For example, a meta-analysis by Evangelista et al [44] found a sensitivity of 85.6% and a specificity of 92.6% for all sites of recurrence, of which there was a pooled sensitivity of 100% for lymph node metastases with a corresponding 81.8% sensitivity. Note this study combines post-RP and post-RT patients, and there is no evidence of a significant difference in performance of choline PET between these 2 scenarios. It is inferior to MRI for detection of local recurrence, but the meta-analysis still showed a 75.4% sensitivity and an 82% specificity for prostatic fossa recurrence detection. In a study of 184 primary RT patients who experienced BCR, and over half of whom had positive confirmatory biopsies of the prostate and/or distant sites, the median PSA level of those patients having a positive choline PET scan was 6.3 ng/mL with a sensitivity and specificity of 95% and 73%, respectively [124]. In another study of 41 patients who underwent salvage RT to the prostate bed only following RP and subsequent biochemical failure, choline PET scans were positive with a median PSA of 3.1 ng/mL and an interquartile range of 1.9 to 5.6 ng/mL. The vast majority of patients had disease that was found outside of the irradiated prostate bed with 61% having disease outside of the pelvis [124,125]. Bone metastasis detection and treatment response evaluation is also very good. Choline requires an on-site cyclotron for generation of the agent because of the short half-life, which restricts where it is feasible to perform.
Post Treatment Follow up of Prostate Cancer. Choline PET/CT Skull Base to Mid-Thigh PET with newer prostate-specific radiotracers has shown excellent performance and great potential for revolutionizing the diagnosis and, consequently, the management of patients with BCR. Choline was the first to receive FDA approval and has been extensively used and studied with several large recent meta-analyses availalable [44,45]. For example, a meta-analysis by Evangelista et al [44] found a sensitivity of 85.6% and a specificity of 92.6% for all sites of recurrence, of which there was a pooled sensitivity of 100% for lymph node metastases with a corresponding 81.8% sensitivity. Note this study combines post-RP and post-RT patients, and there is no evidence of a significant difference in performance of choline PET between these 2 scenarios. It is inferior to MRI for detection of local recurrence, but the meta-analysis still showed a 75.4% sensitivity and an 82% specificity for prostatic fossa recurrence detection. In a study of 184 primary RT patients who experienced BCR, and over half of whom had positive confirmatory biopsies of the prostate and/or distant sites, the median PSA level of those patients having a positive choline PET scan was 6.3 ng/mL with a sensitivity and specificity of 95% and 73%, respectively [124]. In another study of 41 patients who underwent salvage RT to the prostate bed only following RP and subsequent biochemical failure, choline PET scans were positive with a median PSA of 3.1 ng/mL and an interquartile range of 1.9 to 5.6 ng/mL. The vast majority of patients had disease that was found outside of the irradiated prostate bed with 61% having disease outside of the pelvis [124,125]. Bone metastasis detection and treatment response evaluation is also very good. Choline requires an on-site cyclotron for generation of the agent because of the short half-life, which restricts where it is feasible to perform.