A clear limit to the utility of [11C]choline PET/CT scanning

 A recently reported study by a group of German researchers has indicated that [11C]choline PET/CT scanning is not sufficently accurate to be able to identify, localize, and target areas of cancerous tissue within the prostate of a man known to have prostate cancer.

Bundschuh et al. wanted to know whether [11C]choline PET/CT scanning could be used to localize and target areas of cancer within the prostate so that (potentially) these could be treated with high-precision (focal) radiation therapy (or other types of focal therapy).

To do this, they aksed 20 men who already had biopsy-proven prostate cancer, and who were scheduled for treatment by radical prostatectomy to have an [11C]choline PET/CT scan before their surgery. After surgerey was complete, they were then able to carry out a highly detailed comparison of the pathological findings to the results cisible of the PET/CT scans.

Here is what they found:

  • The 20 patients had a total of 28 cancerous lesions based on the detailed pathological results post-surgery.
  • 13/28 lesions (46.4  percent) had corresponding focal [11C]choline uptake visible on the PET/CT scans.
  • 2/28  lesions (7.1 percent) showed no  visible [11C]choline uptake.
  • 13/28 lesions (46.4 percent) showed diffuse [11C]choline uptake that didn’t correspond to the actual tumors found by pathological examination of the tumor specimens.
  • Even for the patients in whom there was correspondence between the pathological findings and the PET/CT scan data, the precision of the correspondence was not good.

Bundschuh et al. conclude that the patterns of uptake of  [11C]choline “corresponded to the histological localization of prostate cancer in fewer than 50 percent of lesions” and that “Even when corresponding visual choline uptake was found, this uptake was highly variable between patients.”

While this study does not rule out the possibility that we may be able to use PET/CT scanning to accurately plan focal therapy for localized prostate cancer at some point in the future, it is clear that — at least in its current form — [11C]choline PET/CT scanning does not have that capability.

One Response

  1. Which shows that a surgical biopsy is more acurate than an [11C]choline PET/CT scan. It may or may not indicate that an [11C]choline scan is less acurate than other non-surgical alternatives.

    I am not informed enough to know how these results compare to other targeting methods in a post-surgery to post-surgery comparison.

    The best choice available to find metastic cancers early may still be an [11C]choline-enhanced scan when the other choice is a scan without enhancement.

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