Positron emission tomography (PET) is an imaging procedure that is unique by virtue of its ability to image biochemical reactions and physiological functions. This is accomplished by measuring concentrations of radioactive chemicals that are partially metabolized in the body region of interest.
PET with fluorodeoxyglucose (FDG) has been quite successful in the imaging evaluation of a large number of tumor types. Prostate cancer, however, has variable accumulation of FDG, which is probably a reflection of the heterogeneous nature of the disease. Early studies of FDG-PET in prostate cancer have shown that FDG accumulation in the primary prostate cancer may be low and overlap with the uptake in benign prostatic hyperplasia, in normal gland, and in postoperative scar or local recurrence. Therefore other radiopharamceutical have been tested. Among them is choline. The utility of 11C-choline and multimodality fusion imaging with integrated PET and contrast-enhanced CT (PET/CT) has been extensively investigated.
A 2009 study of 190 patients found that whole body PET/CT imaging with choline is significantly better than conventional imaging technologies in detecting prostate cancer in patients with biochemical relapse after radical prostatectomy. Researchers also found a strong association between PET/CT detection of recurrent cancer, PSA levels, and PSA kinetics. The authors suggest that based on the results, only patients with a high probability of having a positive scan based on PSA levels and kinetics should undergo choline PET/CT scans. A recent guideline (Jaffri et al) says that the technique requires more study. A 2010 study says that: "Further studies will be needed to decipher the full prognostic utility of the dynamic pattern of osseous metastatic disease from prostate cancer." Greco in 2008 wrote: "role of PET imaging in prostate cancer is gradually evolving but still remains within the experimental realm. Well-conducted studies comparing the merits of different tracers are needed."
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