Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy.
Eur Urol. 2011 Jan;59(1):51-60. doi: 10.1016/j.eururo.2010.09.004. Epub 2010 Sep 15.
Choline positron emission tomography (PET)/computed tomography (CT) is a currently used diagnostic tool in restaging prostate cancer (PCa) patients with increasing prostate-specific antigen (PSA) after either radical prostatectomy (RP) or external-beam radiation therapy (EBRT). However, no final recommendations have been made on the use of this modality for patient management.
To critically analyse the current evidence for the use of choline PET/CT scanning in the management of patients with a progressive increase in PSA after radical treatment for PCa, evaluating its diagnostic accuracy in the detection of recurrences, the clinical predictors of positive PET/CT examinations, and the modalities' role as a guide for tailored therapeutic strategies.
Data on recently published (2003-2010) original articles, review articles, and editorials concerning the role of choline PET/CT in this scenario were analysed.
The diagnostic accuracy of choline PET in detecting sites of PCa relapse has been investigated by several authors, and the overall reported sensitivity ranges between 38% and 98%. It has been demonstrated that choline PET technology's positive detection rate improves with increasing PSA values. The routine use of choline PET/CT cannot be recommended for PSA values <1 ng/ml. However, in addition to PSA serum value, PSA doubling time (PSA DT), and other clinical and pathologic features-including locally advanced tumour (pT3b-T4) or lymph node involvement at initial staging-should be considered to refer patients to choline PET/CT study. Choline PET/CT may be also proposed as a image guide either for experimental surgical or radiation therapy treatments.
According to the current available data, choline PET/CT plays a role in the management of biochemical relapse. Its accuracy is correlated to PSA value, PSA DT, and other pathologic features. Choline PET/CT may be proposed as a guide for individualised treatment of recurrence.
正电子发射断层扫描（PET）/计算机断层扫描（CT）是目前用于前列腺癌（PCa）患者在根治性前列腺切除术（RP）或外照射放疗（EBRT）后 PSA 持续升高时进行分期的诊断工具。然而，对于该方法在患者管理中的应用尚未提出最终建议。
批判性分析目前使用胆碱 PET/CT 扫描在根治性治疗后 PSA 持续升高的 PCa 患者管理中的证据，评估其在检测复发方面的诊断准确性，以及阳性 PET/CT 检查的临床预测因素，以及其作为指导制定个体化治疗策略的作用。
分析了最近发表的（2003-2010 年）关于该场景中胆碱 PET/CT 作用的原始文章、综述文章和社论的数据。
几位作者研究了胆碱 PET 在检测 PCa 复发部位中的诊断准确性，总体报告的敏感性范围在 38%至 98%之间。已经证明，随着 PSA 值的增加，胆碱 PET 技术的阳性检出率提高。常规使用胆碱 PET/CT 不能推荐用于 PSA 值<1ng/ml。但是，除了 PSA 血清值外，PSA 倍增时间（PSA DT）和其他临床和病理特征-包括初始分期时局部晚期肿瘤（pT3b-T4）或淋巴结受累-应考虑将患者转至胆碱 PET/CT 研究。胆碱 PET/CT 也可以作为实验性手术或放射治疗的图像引导。
根据目前的可用数据，胆碱 PET/CT 在生化复发的管理中发挥作用。其准确性与 PSA 值、PSA DT 和其他病理特征相关。胆碱 PET/CT 可以作为复发个体化治疗的指导。
