Diagnostische Wertigkeit der Cholin-PET / CT bei Patienten mit Prostatakarzinom

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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