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The potential role of PET/CT with radiolabeled Choline in patients with treated prostate cancer, has not been established yet and no precise indications exist about the use of this emerging modality. According to the literature, the most useful application of Choline PET/CT is represented by the restaging of the disease in case of biochemical relapse for the detection of local and/or, lymph-nodal and/or distant recurrence. Aim of this brief review is to summarize the results of the most relevant published studies with particular interest to a better understanding of the relationship between PSA, PSA kinetics and Choline PET/CT sensitivity and the potential use of PSA kinetics for an optimal selection of the patient population who may benefit the most from this diagnostic procedure especially early after the biochemical recurrence.

Abstract: It is well known the useful role of 18F-FDG-PET/CT for differential diagnosis between benign and malignant disease, for staging, for monitoring response and for prognosis regarding mesothelioma. Recently, literature was enriched with new interesting studies regarding the potential applications of 18F-FDG-PET/CT in this field. The purpose of this review is to evaluate articles published on line (PubMed) from January 2011 until October 2012 in order to obtain an overview of recent progress of molecular imaging in malignant mesothelioma. The main topics concern the use of 18F-FDG-PET/CT in radiation therapy planning, monitoring of treatment (surgery/chemotherapy) response and prognosis assessment. [Copyright &y& Elsevier]

Purpose: To determine the diagnostic efficacy of C-choline PET/CT in patients with prostate cancer (PC) after radical prostatectomy who presented with increasing PSA levels during follow-up in spite of being on hormone treatment (HT), and therefore showing HT resistance. Methods: We evaluated a large series of 157 consecutive PC patients previously treated by radical prostatectomy who presented with biochemical recurrence with increasing PSA levels in spite of ongoing HT (HT-resistant patients). At the time of C-choline PET/CT, the mean value of trigger PSA level was 8.3 (range 0.2 - 60.6 ng/mL), the mean PSA doubling time (PSAdt) was 5.3 (range 0.4 - 35 months), and the mean PSA velocity (PSAvel) was 22.1 ng/mL/year (range 0.12 - 82 ng/mL/year). C-Choline PET/CT was performed following a standard procedure at our centre to investigate increasing PSA levels, either as the first imaging procedure or in patients with negative conventional imaging. At the time of C-choline PET/CT all patients were receiving HT (61 were receiving monotherapy and 96 multidrug therapy). PET-positive findings were validated by: (a) transrectal US-guided biopsy in patients with recurrence in the prostatic bed, (b) surgical pelvic lymphadenectomy, (c) other imaging modalities, including repeated C-choline PET/CT, performed during a minimum follow-up of 12-months. Results: C-Choline PET/CT showed positive findings in 104 of the 157 patients (66 %). C-choline PET/CT detected: a single lesion in 40 patients (7 in the prostate bed, 10 in lymph nodes, 22 in bone, 1 at another site); two lesions in 18 patients (7 in lymph nodes, 7 in bone, 4 in both lymph nodes and bone); three or four lesions in 7 patients (4 in lymph nodes, 2 in bone, 1 at another site); and more than four lesions in the remaining 39 patients (2 in the prostate bed, 12 in lymph nodes, 12 in bone, 11 in both lymph nodes and bone, 2 at other sites). In C-choline PET-negative patients, the mean values of trigger PSA, PSAdt and PSAvel were 3.8 ng/mL (range 0.2 - 11.9 ng/mL) 7.0 months (range 1.21 - 35 months) and 5.8 ng/mL/year (range 0.12 - 30.1) respectively, while in C-Choline-PET-positive patients they were 10.5 ng/mL (range 0.2 - 60.6), 4.4 months (range 0.4 - 19.7) and 15.9 ng/mL/year (range 0.5 - 82.0) respectively. The differences between PET-negative and PET-positive patients were statistically significant for all these parameters: trigger PSA, p < 0.01; PSAdt, p < 0.01; PSAvel, p = 0.03. Conclusion: In our patient population, C-choline PET/CT was able to detect relapsed disease in a large proportion of HT-resistant PC patients during HT. These data, obtained in a large series, suggest that HT withdrawal before performing a C-choline PET/CT scan may not be necessary for the detection of recurrent disease if PSA levels are increasing and PSA kinetics are rapid. [ABSTRACT FROM AUTHOR]

Purpose: The influence of androgen deprivation therapy (ADT) on C-choline uptake in patients with prostate cancer (PC) has not yet been clarified. The aim of our study was to investigate this issue by means of sequential C-choline positron emission tomography (PET)/CT in patients with recurrent PC. Methods: We retrospectively studied 14 recurrent PC patients (mean age 67 years, range 55-82) during follow-up after radical prostatectomy (RP) with rising serum prostate-specific antigen (PSA) levels. All patients had undergone at least two consecutive C-choline PET/CT scans: the first C-choline PET/CT before commencing ADT and the second C-choline PET/CT after 6 months of ADT administration. Results: The mean serum PSA level before ADT was 17.0 ± 44.1 ng/ml. After 6 months of ADT administration the PSA value significantly decreased in comparison to baseline (PSA = 2.4 ± 3.1 ng/ml, p < .025). Moreover, before starting ADT, 13 of 14 patients had positive C-choline PET/CT for metastatic spread, while after 6 months of ADT administration in 9 of 14 patients C-choline PET/CT became negative. Conclusion: These preliminary results suggest that ADT significantly reduces C-choline uptake in androgen-sensitive PC patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the potential usefulness of whole-body C-choline PET/CT in the re-staging of prostate cancer (PC) patients previously treated with radical prostatectomy (RP), who presented a mild increase of prostate-specific antigen (PSA) <1.5 ng/ml (early biochemical relapse) during follow-up (FU). Methods: We evaluated 102 consecutive patients (mean age = 68 years, range = 54-82 years) previously treated with RP and who presented during FU a mild increase of trigger PSA serum levels <1.5 ng/ml: mean 0.86 ± 0.40 ng/ml (range 0.2-1.5) and median 0.93 ng/ml (range 0.67-1.10). In this patient series C-choline PET/CT was used as the first imaging examination at the time of the detection of a mild serum PSA increase <1.5 ng/ml. C-Choline PET/CT was performed following standard procedures in our centre. At the time of PET/CT, 86 patients were not receiving any pharmacologic treatment, while 16 were under anti-androgenic therapy. Positive PET findings were validated by: (a) transrectal ultrasound (TRUS)-guided biopsy in cases of local recurrence, (b) surgical lymphadenectomy, (c) other imaging procedures or (d) FU lasting for at least 12 months. Univariate and multivariate analyses were used to evaluate the following variables: age, TNM staging, Gleason score, time from RP to the biochemical relapse, anti-androgen therapy at the time of C-choline PET/CT scan, trigger PSA value and PSA kinetics, i.e. PSA doubling time (PSAdt) and PSA velocity (PSAvel), in order to assess the significant predictive factors related to the findings of a positive C-choline PET/CT scan. Results: Overall, C-choline PET/CT showed positive findings in 29 of 102 patients (28% of cases). In detail, C-choline PET/CT detected: local relapse in 7 patients, bone metastases in 13 patients (4 single and 9 multiple) and lymph node metastases in 9 patients (6 single and 3 multiple). Positive PET findings were validated by: (a) TRUS-guided biopsy in 7 patients with local recurrence, (b) surgery and lymphadenectomy in 3 patients, (c) other targeted imaging procedures (MR or bone scan) in 5 patients and (d) clinical FU lasting a minimum of 12 months and including also a contrast-enhanced CT (CECT), an MR, a bone scan and a repeated C-choline PET/CT in 14 patients. Age, time to biochemical relapse (TTR), initial T staging, Gleason score and trigger PSA were not statistically significant in predicting a positive C-choline PET/CT scan both at univariate and multivariate analysis. Instead, PSA kinetics (PSAdt and PSAvel), N status and anti-androgenic therapy at the time of PET scan were statistically significant predictive factors at univariate analysis. Of note, only PSAdt and initial N status were found to be significant and independent predictive factors at multivariate analysis. The mean PSAdt in PET-positive patients was 4.34 months (SD 2.82) while in PET-negative patients it was 13.30 months (SD 9.75) ( p = 0.0001). The optimal threshold for PSAdt established by receiver-operating characteristic (ROC) analysis was 7.25 months (AUC 0.85; 95% confidence interval 0.77-0.91) providing 93% sensitivity, 74% specificity, 60% positive predictive value and 96% negative predictive value. Conclusion: In our study, C-choline PET/CT was able to detect recurrent disease in 28% of the patients with mild biochemical relapse characterized by very low trigger PSA levels (PSA <1.5 ng/ml). Very interestingly C-choline PET/CT detected distant unexpected metastases in 21% of the patients. At multivariate statistical analysis only PSAdt and node status were shown to be significant and independent predictive factors for positive C-choline PET/CT. Therefore, C-choline could be suggested to be performed early during initial biochemical relapse in patients presenting with fast PSA kinetics. The early detection of the site of recurrence could lead to a prompt instauration of the most appropriate treatment, i.e. local surgery or radiation treatment vs systemic treatment. In this view, one of the main advantages should be the avoidance of unnecessary local radiotherapy in those patients showing distant metastasis at C-choline PET/CT. [ABSTRACT FROM AUTHOR]

To assess the utility of 11C-choline PET/CT in the restaging of prostate cancer (PC) patients who showed a single finding on bone scintigraphy (BS) that was classified as equivocal or suspected for metastatic lesion. A total of 25 PC patients with biochemical failure (mean PSA value 11.1 ng/mL; median value 6.3 ng/mL; range 0.2–37.7 ng/mL) after primary treatment were included in this retrospective study. All of them showed a single lesion on BS reported as suspected for metastatic lesion or as equivocal finding. Patients underwent 11C-choline PET/CT within 1–4 months from BS. Validation was established by follow-up for at least 6 months. On the basis of biopsy confirmation and/or 6-month follow-up, 22 of 25 patients were classified as positive for the presence of metastatic bone lesions: 13 with a single lesion and 9 with multiple lesions. 11C-choline PET/CT was positive in 19/25 patients and, on a lesion basis, it showed 50 positive findings. BS results were confirmed in 8/25 (32%) patients. 11C-choline PET/CT detected multiple sites of relapse in 11/25 (44%) patients: in 2/11, a single bone lesion associated with other extraosseous sites of relapse; in 6/11, multiple bone lesions; in 3/11, multiple bone lesions and other extraosseous localizations. Finally, 6/25 patients were negative on 11C-choline PET/CT. In 3/6 patients, an osteoblastic lesion was seen on CT attenuation correction images (PET false negative; BS true positive), while in 3/6 patients only findings suggestive of the presence of degenerative disease were found (PET true negative; BS false positive). On a patient basis, 11C-choline PET/CT showed a diagnostic sensitivity of 86% (19/22) and a specificity of 100% (19/19). In our study, 11C-choline PET/CT detected unknown lesions in 11/25 patients. Patients with a single equivocal finding on BS could have important additional information from 11C-choline PET/CT study, especially in the detection of additional metastases, to choose an appropriate treatment. [ABSTRACT FROM AUTHOR]

The potential role of PET/CT with radiolabeled Choline in patients with treated prostate cancer, has not been established yet and no precise indications exist about the use of this emerging modality. According to the literature, the most useful application of Choline PET/CT is represented by the restaging of the disease in case of biochemical relapse for the detection of local and/or, lymph-nodal and/or distant recurrence. Aim of this brief review is to summarize the results of the most relevant published studies with particular interest to a better understanding of the relationship between PSA, PSA kinetics and Choline PET/CT sensitivity and the potential use of PSA kinetics for an optimal selection of the patient population who may benefit the most from this diagnostic procedure especially early after the biochemical recurrence. [ABSTRACT FROM AUTHOR]

The potential role of PET/CT with radiolabeled Choline in patients with treated prostate cancer, has not been established yet and no precise indications exist about the use of this emerging modality. According to the literature, the most useful application of Choline PET/CT is represented by the restaging of the disease in case of biochemical relapse for the detection of local and/or, lymph-nodal and/or distant recurrence. Aim of this brief review is to summarize the results of the most relevant published studies with particular interest to a better understanding of the relationship between PSA, PSA kinetics and Choline PET/CT sensitivity and the potential use of PSA kinetics for an optimal selection of the patient population who may benefit the most from this diagnostic procedure especially early after the biochemical recurrence. [ABSTRACT FROM AUTHOR]

The article presents a case study of the use of 18F-fluoride Positron Emission Tomography-Computed Tomography (PET/CT) for detecting bone metastasis in patients with clear cell renal cell carcinoma (RCC). In the given patient, PET/CT showed multiple pathological bone lesions including the scapula, stemum, right rib, and pelvis. However, bone scintigraphy (BS) showed only faint images.

Abstract: Aim: to evaluate the utility of 11C-choline PET/CT in prostate cancer (PC) patients who have demonstrated a biochemical recurrence and a negative bone scintigraphy (BS). Materials and methods: 123 consecutive PC patients (mean age 67.6 years; range 54–83) with a biochemical relapse (mean PSA value 3.3ng/mL; range 0.2–25.5) after radical prostatectomy (RP) were included in our retrospective study. Patients underwent a BS that resulted negative and a 11C-choline PET/CT within 4 months from BS (range: 1 day to 4 months; mean: 2.5 months). Validation of results was established by: (1) a positive biopsy, (2) a positive subsequent BS, CT or MR and (3) a normalization of 11C-choline uptake after systemic therapy or a progression of the disease. Results: 11C-choline PET/CT was positive in 42/123 patients (34.1%). 11C-choline PET/CT detected lesions in: bone (10 patients), lymph-nodes (20 patients), bone and lymph nodes (7 patients), bone and lung (1 patient), lymph-nodes and lung (1 patient), local relapse (3 patients). Overall, 11C-choline PET/CT showed a total of 30 unknown bone lesions in 18/123 (14.6%) patients. Conclusion: 11C-choline PET/CT showed a better sensitivity than BS in patients with biochemical relapse after RP: 11C-choline PET/CT detected unknown bone lesions in 18/123 (14.6%) patients. [Copyright &y& Elsevier]

Purpose: To evaluate the effect of the use of 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in radiotherapy target delineation for head-and-neck cancer compared with CT alone. Methods and Materials: A total of 38 consecutive patients with head-and-neck cancer were included in this study. The primary tumor sites were as follow: 20 oropharyngeal tumors, 4 laryngeal tumors, 2 hypopharyngeal tumors, 2 paranasal sinuses tumors, 9 nasopharyngeal tumors, and 1 parotid gland tumor. The FDG-PET and CT scans were performed with a dedicated PET/CT scanner in one session and then fused. Subsequently, patients underwent treatment planning CT with intravenous contrast enhancement. The radiation oncologist defined all gross tumor volumes (GTVs) using both the PET/CT and CT scans. Results: In 35 (92%) of 38 cases, the CT-based GTVs were larger than the PET/CT-based GTVs. The average total GTV from the CT and PET/CT scans was 34.54 cm3 (range, 3.56–109) and 29.38 cm3 (range, 2.87–95.02), respectively (p < 0.05). Separate analyses of the difference between the CT- and PET/CT-based GTVs of the primary tumor compared with the GTVs of nodal disease were not statistically significant. The comparison between the PET/CT-based and CT-based boost planning target volumes did not show a statistically significant difference. All patients were alive at the end of the follow-up period (range, 3–38 months). Conclusion: GTVs, but not planning target volumes, were significantly changed by the implementation of combined PET/CT. Large multicenter studies are needed to ascertain whether combined PET/CT in target delineation can influence the main clinical outcomes. [Copyright &y& Elsevier]

It is well known the useful role of ¹⁸F-FDG-PET/CT for differential diagnosis between benign and malignant disease, for staging, for monitoring response and for prognosis regarding mesothelioma. Recently, literature was enriched with new interesting studies regarding the potential applications of ¹⁸F-FDG-PET/CT in this field. The purpose of this review is to evaluate articles published on line (PubMed) from January 2011 until October 2012 in order to obtain an overview of recent progress of molecular imaging in malignant mesothelioma. The main topics concern the use of ¹⁸F-FDG-PET/CT in radiation therapy planning, monitoring of treatment (surgery/chemotherapy) response and prognosis assessment., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)