Download PDF
Der Nuklearmediziner 2015; 38(02): 109-118
DOI: 10.1055/s-0035-1549861
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Die Cholin-PET/CT für Diagnostik, Staging und Restaging des Prostatakarzinoms

Choline PET/CT for Diagnosis, Staging and Restaging of Prostate Cancer
M. Heuschkel
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Rostock
,
B. J. Krause
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Rostock
,
O. W. Hakenberg
2   Urologische Klinik und Poliklinik, Universitätsmedizin Rostock
,
S. M. Schwarzenböck
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Rostock
› Author Affiliations
Further Information

Publication History

Publication Date:
09 June 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die rechtzeitige Diagnose und ein adäquates Staging des Prostatakarzinoms sind essenzielle Voraussetzungen für die Wahl des optimalen Therapieverfahrens. Die Verwendung von F-18 und C-11 markierten Cholinderivaten in der PET/CT-Diagnostik hat in den letzten Jahren zunehmend Einzug in die Diagnostik des Prostatakarzinoms genommen. Der Nutzen der Cholin-PET/CT in der Primärdiagnostik wurde in vielen Studien kontrovers diskutiert. Im Großteil der Studien zeigte sich eine Limitation in der Diagnose des Primärtumors, insbesondere in Abhängigkeit der Tumorkonfiguration (kleine und schalenförmige Tumoren) und in der Abgrenzung zu benignen Läsionen (BPH, HG-PIN, Prostatitis), sodass sich hier kein regulärer Einsatz in der diagnostischen Routine empfiehlt. Auch für die Detektion von Lymphknotenmetastasen ergibt sich in der Primärsituation nur eine eingeschränkte Sensitivität der Cholin-PET-CT (bei adäquater Spezifität). Hier kann die Cholin-PET/CT ggf. bei High-risk-Patienten vor Therapie/im Rahmen der Therapieplanung eingesetzt werden. Beim Restaging des Prostatakarzinoms bei biochemischem Rezidiv stellt die Cholin-PET/CT ein bedeutendes Verfahren dar. Die Detektionsrate ist hierbei abhängig vom PSA-Wert, der PSA-Kinetik und der PSA-Verdopplungszeit, ebenso vom initialen Gleason-Score, sodass die Detektionsrate auch bei einem PSA<1 ng/ml von insgesamt ca. 30% in Kombination mit einem höheren Gleason-Score auf bis zu 50% ansteigt. Im Restaging bei biochemischem Rezidiv zeigt sich eine gute Sensitivität und Spezifität. Die Cholin-PET/CT führt hierbei in bis zu 60% der Fälle zur Änderung bzw. Anpassung des Therapieregimes, z. B. im Rahmen der Bestrahlungsplanung. Für die fortgeschrittene Tumorerkrankung mit ossärer Metastasierung ergibt sich ebenfalls eine hohe Spezifität für die Cholin-PET/CT, bez. der Sensitivität ist diese jedoch der Skelettszintigrafie einschließlich SPECT unterlegen. Erste Daten deuten außerdem darauf hin, dass sich ein signifikanter Überlebensvorteil für Patienten ergibt, die bei PSA-Anstieg keine vermehrte Cholin-Aufnahme zeigen.

Abstract

Early diagnosis and accurate staging are crucial for the optimal choice of treatment in prostate cancer. F-18 and C-11 labelled choline derivatives are increasingly used for PET/CT imaging. The value of choline PET/CT in primary staging of prostate cancer is actually discussed controversially. Most studies have shown a limited sensitivity of choline PET/CT in primary diagnosis depending on the tumor configuration (especially small and rim-like tumors) and a limited specificity in the differentiation between prostate cancer and benign prostate lesions such as BPH, HGPIN and prostatitis. Due to the limited specificity, routine use of choline PET/CT is not recommended. With respect to nodal staging, sensitivity of choline PET/CT is limited in the primary setting, although the specificity is adequate. However, choline PET/CT might be used in staging of high risk patients before therapy planning. Sensitivity and specificity of choline PET/CT is valuable in restaging patients with biochemical recurrence. The detection rate depends on the PSA serum level, PSA kinetics and PSA doubling time as well as on the Gleason score. Detection rate in patients with a PSA level>1 ng/ml ranges between 30 and 50% (dependent on Gleason score). Choline PET/CT leads to a change of treatment in up to 60% of patients, i. e. in radiation treatment planning. In case of advanced disease choline PET/CT has a high specificity in the detection of bone metastases, however, bone scintigraphy (SPECT) provides higher sensitivity. Preliminary data have shown a significant better survival in patients with biochemical recurrence and negative findings in choline PET/CT.

Schlüsselwörter

Prostatakarzinom - Cholin - PET/CT

Key words

prostate cancer - choline - PET/CT
 

  • Literatur

  • 1 Ackerstaff E, Glunde K, Bhujwalla ZM. Choline phospholipid metabolism: a target in cancer cells?. J Cell Biochem 2003; 90: 525-533
    CrossrefPubMedGoogle Scholar
  • 2 Ackerstaff E, Pflug BR, Nelson JB et al. Detection of increased choline compounds with proton nuclear magnetic resonance spectroscopy subsequent to malignant transformation of human prostatic epithelial cells. Cancer Res 2001; 61: 3599-3603
    PubMedGoogle Scholar
  • 3 Alongi F, Comito T, Villa E et al. What is the role of [11C]choline PET/CT in decision making strategy before post-operative salvage radiation therapy in prostate cancer patients?. Acta Oncol 2014; 53: 990-992
    CrossrefPubMedGoogle Scholar
  • 4 Bundschuh RA, Wendl CM, Weirich G et al. Tumor volume delineation in prostate cancer assessed by [11C]choline PET/CT: validation with surgical specimens. Eur J Nucl Med Mol Imaging 2013; 40: 824-831
    CrossrefPubMedGoogle Scholar
  • 5 Casciani E, Gualdi GF. Prostate cancer: value of magnetic resonance spectroscopy 3D chemical shift imaging. Abdom Imaging 2006; 31: 490-499
    CrossrefPubMedGoogle Scholar
  • 6 Castellucci P, Ceci F, Graziani T et al. Early biochemical relapse after radical prostatectomy: which prostate cancer patients may benefit from a restaging 11C-Choline PET/CT scan before salvage radiation therapy?. J Nucl Med 2014; 55: 1424-1429
    CrossrefPubMedGoogle Scholar
  • 7 Castellucci P, Fuccio C, Nanni C et al. Influence of trigger PSA and PSA kinetics on 11C-Choline PET/CT detection rate in patients with biochemical relapse after radical prostatectomy. J Nucl Med 2009; 50: 1394-1400
    CrossrefPubMedGoogle Scholar
  • 8 Ceci F, Castellucci P, Graziani T et al. 11C-choline PET/CT detects the site of relapse in the majority of prostate cancer patients showing biochemical recurrence after EBRT. Eur J Nucl Med Mol Imaging 2014; 41: 878-886
    CrossrefPubMedGoogle Scholar
  • 9 Ceci F, Herrmann K, Castellucci P et al. Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial. Eur J Nucl Med Mol Imaging 2014; 41: 2222-2231
    CrossrefPubMedGoogle Scholar
  • 10 Cimitan M, Evangelista L, Hodolič M et al. Gleason Score at Diagnosis Predicts the Rate of Detection of 18F-Choline PET/CT Performed When Biochemical Evidence Indicates Recurrence of Prostate Cancer: Experience with 1,000 Patients. J Nucl Med 2015; 56: 209-215
    CrossrefPubMedGoogle Scholar
  • 11 Evangelista L, Guttilla A, Zattoni F et al. Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis. Eur Urol 2013; 63: 1040-1048
    CrossrefPubMedGoogle Scholar
  • 12 Evangelista L, Zattoni F, Guttilla A et al. Choline PET or PET/CT and biochemical relapse of prostate cancer: a systematic review and meta-analysis. Clin Nucl Med 2013; 38: 305-314
    CrossrefPubMedGoogle Scholar
  • 13 Farsad M, Schiavina R, Castellucci P et al. Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis. J Nucl Med 2005; 46: 1642-1649
    PubMedGoogle Scholar
  • 14 Farsad M, Schwarzenboeck S, Krause BJ. PET/CT and choline: diagnosis and staging. Q J Nucl Med Mol Imaging 2012; 56: 343-353
    PubMedGoogle Scholar
  • 15 Giovacchini G, Picchio M, Garcia-Parra R et al. 11C-choline PET/CT predicts prostate cancer-specific survival in patients with biochemical failure during androgen-deprivation therapy. J Nucl Med 2014; 55: 233-241
    CrossrefPubMedGoogle Scholar
  • 16 Goldstein J, Even-Sapir E, Ben-Haim S et al. Does Choline PET/CT Change the Management of Prostate Cancer Patients With Biochemical Failure?. Am J Clin Oncol 2014; ahead of print
    PubMedGoogle Scholar
  • 17 Hara T, Bansal A, DeGrado TR. Choline transporter as a novel target for molecular imaging of cancer. Mol Imaging 2006; 5: 498-509
    PubMedGoogle Scholar
  • 18 Jereczek-Fossa BA, Rodari M, Bonora M et al. [11C]choline PET/CT impacts treatment decision making in patients with prostate cancer referred for radiotherapy. Clin Genitourin Cancer 2014; 12: 155-159
    CrossrefPubMedGoogle Scholar
  • 19 Kaatsch P, Spix C, Hentschel S et al. Beiträge zur Gesundheitsberichterstattung des Bundes – Krebs in Deutschland 2009/2010. 9. Ausgabe Robert Koch-Institut , Hrsg und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. . Hrsg Berlin: 2013
    Google Scholar
  • 20 Katz-Brull R, Degani H. Kinetics of choline transport and phosphorylation in human breast cancer cells; NMR application of the zero trans method. Anticancer Res 1996; 16: 1375-1380
    PubMedGoogle Scholar
  • 21 Krause BJ, Souvatzoglou M, Tuncel M et al. The detection rate of [11C]choline-PET/CT depends on the serum PSA-value in patients with biochemical recurrence of prostate cancer. Eur J Nucl Med Mol Imaging 2008; 35: 18-23
    CrossrefPubMedGoogle Scholar
  • 22 Picchio M, Spinapolice EG, Fallanca F et al. [11C]Choline PET/CT detection of bone metastases in patients with PSA progression after primary treatment for prostate cancer: comparison with bone scintigraphy. Eur J Nucl Med Mol Imaging 2012; 39: 13-26
    CrossrefPubMedGoogle Scholar
  • 23 Ramirez de Molina A, Rodriguez-Gonzalez A, Gutiérrez R et al. Overexpression of choline kinase is a frequent feature in human tumor-derived cell lines and in lung, prostate, and colorectal human cancers. Biochem Biophys Res Commun 2002; 296: 580-583
    CrossrefPubMedGoogle Scholar
  • 24 Ratnam S, Kent C. Early increase in choline kinase activity upon induction of the H-ras oncogene in mouse fibroblast cell lines. Arch Biochem Biophys 1995; 323: 313-322
    CrossrefPubMedGoogle Scholar
  • 25 Rigatti P, Suardi N, Briganti A et al. Pelvic/retroperitoneal salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography. Eur Urol 2011; 60: 935-943
    CrossrefPubMedGoogle Scholar
  • 26 Schöder H, Larson SM. Positron emission tomography for prostate, bladder and renal cancer. Semin Oncol 2003; 30: 616-634
    CrossrefPubMedGoogle Scholar
  • 27 Shen G, Deng H, Hu S et al. Comparison of choline-PET/CT, MRI, SPECT, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a meta-analysis. Skeletal Radiol 2014; 43: 1503-1513
    CrossrefPubMedGoogle Scholar
  • 28 Smith RA, Cokkinides V, Eyre HJ et al. Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects. CA Cancer J Clin 2007; 57: 90-104
    CrossrefPubMedGoogle Scholar
  • 29 Souvatzoglou M, Krause BJ, Pürschel A et al. Influence of (11)C-choline PET/CT on the treatment planning for salvage radiation therapy in patients with biochemical recurrence of prostate cancer. Radiother Oncol 2011; 99: 193-200
    CrossrefPubMedGoogle Scholar
  • 30 Souvatzoglou M, Weirich G, Schwarzenboeck S et al. The sensitivity of [11C]choline PET/CT to localize prostate cancer depends on the tumor configuration. Clin Cancer Res 2011; 17: 3751-3759
    CrossrefPubMedGoogle Scholar
  • 31 Treglia G, Ceriani L, Sadeghi R et al. Relationship between prostate-specific antigen kinetics and detection rate of radiolabelled choline PET/CT in restaging prostate cancer patients: a meta-analysis. Clin Chem Lab Med 2014; 52: 725-733
    CrossrefPubMedGoogle Scholar
  • 32 Umbehr MH, Müntener M, Hany T et al. The role of 11C-choline and 18F-fluorocholine positron emission tomography (PET) and PET/CT in prostate cancer: a systematic review and meta-analysis. Eur Urol 2013; 64: 106-117
    CrossrefPubMedGoogle Scholar
  • 33 Von Eyben FE, Kairemo K. Meta-analysis of (11)C-choline and (18)F-choline PET/CT for management of patients with prostate cancer. Nucl Med Commun 2014; 35: 221-230
    CrossrefPubMedGoogle Scholar
  • 34 Wondergem M, van der Zant FM, van der Ploeg T et al. A literature review of 18F-fluoride PET/CT and 18F-choline or 11C-choline PET/CT for detection of bone metastases in patients with prostate cancer. Nucl Med Commun 2013; 34: 935-945
    CrossrefPubMedGoogle Scholar