In general, choline PET/CT performs poorly in the staging of primary disease but improves upon conventional CT and multi-parametric magnetic resonance imaging (mpMRI) in the detection of metastatic lesions in biochemical recurrence. 18F-fluciclovine and PSMA PET/CT show promise in staging both primary disease and biochemical recurrence. For all modalities, performance in the biochemical recurrence setting depends upon prostate-specific antigen (PSA) concentration: lower concentrations correspond to less precision. In addition, the clinical significance of small, occult metastases detected at lower PSA concentrations remains unclear.
The take-home message is that clinicians should keep abreast of developments in PET/CT for prostate cancer—in particular, choline-, fluciclovine-, and PSMA-based modalities—and consider its use for assessing metastatic burden in biochemical recurrence. Further studies are forthcoming regarding its use in the assessment of primary disease.
Written by: J. Kellogg Parsons, MD, MHS, a board-certified urologist and Professor of Urology who specializes in treating prostate cancer, benign prostatic hyperplasia (BPH), bladder cancer, and kidney cancer. Dr. Parsons currently serves as a consulting editor for European Urology and European Urology Focus, and is an associate editor for Prostate Cancer and Prostatic Diseases.
Read the Full-Text Article: The Use of PET/CT in Prostate Cancer