Zusammenfassung
Die Cholin-Positronen-Emissionstomografie/Computertomografie (Cholin-PET/CT) wird
zunehmend zur Bildgebung des Prostatakarzinoms (PCA) angewandt. In der vorliegenden
Übersichtsarbeit werden die Relevanz der Cholin-PET/CT in Primärdiagnostik, Staging
und Rezidivdiagnostik des PCA näher beleuchtet und sinnvolle Einsatzmöglichkeiten
in der klinischen Praxis aufgezeigt. Hierzu erfolgte eine systematische Literaturrecherche
über die elektronischen Datenbanken Pubmed und Medline nach Originalarbeiten, Übersichtsarbeiten
und Leitartikeln zum Thema Cholin-PET/CT und Prostatakarzinom. In der Primärdiagnostik
des PCA kann die Durchführung einer Cholin-PET/CT-Untersuchung aufgrund fehlender
valider Daten nicht grundsätzlich empfohlen werden. In der Ausbreitungsdiagnostik
nimmt die Cholin-PET/CT zur Beurteilung des lokalen Tumorwachstums (T-Staging) aufgrund
ihrer geringen räumlichen Auflösung einen untergeordneten Stellenwert ein. Bei der
Beurteilung des Lymphknotenstatus (N-Staging) weist sie einen hohen positiv prädiktiven
Wert auf und in der Detektion von Knochenmetastasen (M-Staging) zeigt sie gegenüber
der konventionellen Ganzkörperskelettszintigrafie vergleichbare Ergebnisse. In der
Rezidivdiagnostik scheint die Cholin-PET/CT für Patienten, die nach bestimmten Kriterien
(PSA-Wert > 1,0 ng/ml und/ oder PSA-doubling-time < 6 Monate und/oder Gleason-Score
> 7 und/oder Radiatio als Primärtherapie) selektioniert wurden, eine geeignete Untersuchung
zur Unterscheidung eines Lokalrezidives von einem systemischen Rezidiv zu sein. Die
routinemäßige, unkritische Anwendung der Cholin-PET/CT bei Patienten mit PCA erscheint
nicht zuletzt aufgrund der hohen Kosten der Untersuchung als wenig sinnvoll. Sie sollte
nach sorgfältiger Auswahl von geeigneten Patienten auf bestimmte klinische Fragestellungen
angewandt werden.
Abstract
The choline-positron emissiontomography/computed tomography (choline-PET/CT) is a
widely used imaging method for prostate cancer. This review concentrates on the relevance
of choline-PET/CT for primary diagnosis, staging and restaging of prostate cancer
and highlights possible applications in clinical practice. Therefore, we performed
a systematic literature research via Pubmed and Medline database for original articles,
reviews and editorials on choline-PET/CT and prostate cancer. Choline-PET/CT should
not be routinely used for primary diagnosis of prostate cancer due to a lack of data.
With regard to the definition of the local tumour extent (T-staging) choline-PET/CT
plays only a minor role, in contrast, for the evaluation of lymph node involvement
it has a high positive predictive value and is equal to conventional scintigraphy
in detecting bone metastases. Moreover, in cases of biochemical relapse following
local therapy, choline-PET/CT seems to be appropriate for differentiating between
local recurrence and systemic prostate cancer metastasis, particularly when patients
are selected by defined criteria (PSA value > 1.0 ng/mL and/or PSAdt < 6 months and/or
Gleason score > 7 and/or primary radiotherapy). The non-critical routine use of choline-PET/CT
for patients with prostate cancer cannot be recommended, and this not only because
of its high costs. It should be applied to definite clinical questions after thorough
selection of appropriate patients.
Schlüsselwörter
Cholin-PET/CT - Prostatakarzinom - Primärdiagnostik - Staging - biochemisches Prostatakarzinomrezidiv
Key words
choline-PET/CT - prostate cancer - primary diagnosis - staging - biochemical recurrence
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Dr. F. Zengerling
Klinik für Urologie · Universitätsklinikum Ulm
Prittwitzstraße 43
89075 Ulm
eMail: friedemann.zengerling@uniklinik-ulm.de
