PET imaging in prostate cancer, state of the art: a review of 18F-choline and 11C-choline PET/CT applications

The aim of this paper is to review the role of 18F-choline or 11C-cholinePET/CT in prostate cancer patients for diagnosis, staging and restaging in case of biochemical recurrence and on the use of 18F-choline or 11C-choline PET/CT for metastases directed salvage therapies and in castrate-resistant patients treated with systemic therapy. A literature search was performed, and articles related to 11C-choline and 18F-choline PET/CT in prostate cancer staging and biochemical relapse were identified. Search terms were: “PET” and “PET/CT”, “11C-choline”, “18F-choline”, “prostate cancer staging”, “lymph node staging” “biochemical recurrence”. We have reported the results of the most relevant publications following the criteria of clinical relevance, confirmations of choline PET/CT findings with histology, other imaging methods or clinical follow-up. Moreover, we have briefly reported about the use of 18F-choline or 11C-choline PET/CT for prostate cancer diagnosis and to monitor castrate-resistant prostate cancer (CRPC) patients treated with systemic therapy. In lymph node and distant staging choline, PET/CT showed low sensitivity but, in most of the cases, a relatively high specificity. In case of biochemical recurrence, PSA absolute value and PSA kinetics confirmed their strict correlation with choline PET/CT findings. Choline PET/CT resulted to be very useful to address salvages therapies, especially in the early phases of biochemical recurrence. The use of choline PET/CT in CRPC should be more deeply investigated. At the moment, its use in the diagnosis of prostate cancer is not recommended. 18F-choline or 11C-choline PET/CT provides useful information to clinicians mostly in case of biochemical recurrence, while the low sensitivity limits its use during staging.