State of the PET/CT with 11-choline and 18F-fluorocholine in the diagnosis and follow-up of localized and locally advanced prostate / Estado del PET TAC con Colina 11C y Fluorocolina 18F en el diagnóstico y seguimiento del cáncer de próstata localizado y localmente avanzado

ABSTRACT

OBJECTIVE: To provide an updated state of the art about the role of positron emission tomography/ computed tomography (PET/CT) with 11C-Choline and 18F-fluorocholine in the localized and locally advanced Prostate Cancer (PCa) in the staging and restaging setting. METHODS: We performed a non-systematic review of the literature based on a free-text search in the National Library of Medicine Database (MEDLINE) to select English-language published papers evaluating PET and PET/CT imaging with radiolabelled choline in initial diagnosis and in post-treatment phase in PCa patients. RESULTS: PET and PET/CT with 11C-choline and 18F-fluorocholine have been largely investigated as non-invasive diagnostic tools in PCa. Actually, the relatively high rate of false negative findings due to the small dimension of neoplastic lesions and the available spatial resolution of PET tracers limits the routine use of choline PET and PET/CT in staging setting; moreover, it cannot reliably replace the lymph node (LN) dissection for detecting LN involvement. On restaging setting, Choline PET/CT showed a higher accuracy than conventional imaging modalities, especially in the detection of LN and systemic metastases, while it is less accurate than magnetic resonance imaging in the detection of local relapse. CONCLUSION: In the Prostate Specific Antigen (PSA) era with a large number of localized disease, the diagnostic performance of choline PET and PET/CT lack of reliability in initial diagnosis of PCa. The major clinical role of choline PET/CT is the re-staging of patients with a biochemical relapse after radical treatment; the promising performance of choline PET/CT scan in patients with low levels of PSA could also lead the clinicians for to perform PET-guided adjuvant curative therapies or palliative treatments in patients already treated radically for PCa

RESUMEN

OBJETIVOS: Ofrecer una puesta al día de lo último sobre el papel de la tomografía por emisión de positrones/Tomografía axial computarizada (PET/TAC) con colina 11C y fluorocolina 18 F en el cáncer de próstata (CaP) localizado y localmente avanzado. MÉTODOS: Realizamos una revisión no sistemática de la literatura basada en una búsqueda de texto libre en la Base de Datos de la Biblioteca nacional de Medicina (MEDLINE) para seleccionar las publicaciones en lengua inglesa que evaluaban la PET y PET/TAC con colina radiomarcada en el diagnóstico inicial y en la fase posterior al tratamiento en pacientes con CaP. RESULTADOS: El PET y PET/TAC con colina 11C y fluorocolina 18F han sido ampliamente investigados como herramientas diagnósticas no invasivas en el CaP. Realmente, la relativamente alta tasa de hallazgos falsos negativos debido a la pequeña dimensión de las lesiones neoplásicas y la resolución espacial disponible para los marcadores PET limitan la utilización rutinaria de PET y PET/TAC en el estadiaje; además, no puede reemplazar de una forma fiable a la linfadenectomía para detectar la afectación de los ganglios linfáticos. En re-estadiaje, el PET/TAC colina mostró una precisión superior a las modalidades radiológicas convencionales, especialmente en la detección de ganglios linfáticos y metástasis sistémicas, mientras que es menos preciso que la resonancia magnética en la detección de la recidiva local. CONCLUSION: In the Prostate Specific Antigen (PSA) era with a large number of localized disease, the diagnostic performance of choline PET and PET/CT lack of reliability in initial diagnosis of PCa. The major clinical role of choline PET/CT is the re-staging of patients with a biochemical relapse after radical treatment; the promising performance of choline PET/CT scan in patients with low levels of PSA could also lead the clinicians for to perform PET-guided adjuvant curative therapies or palliative treatments in patients already treated radically for PCa