New Clinical Indications for 18F/11C-choline, New Tracers for Positron Emission Tomography and a Promising Hybrid Device for Prostate Cancer Staging: A Systematic Review of the Literature

Laura Evangelista, Alberto Briganti, Stefano Fanti, Stephen Joniau, Sven Reske, Riccardo Schiavina, Christian Stief, George N. Thalmann, Maria Picchio

Research output: Contribution to journalArticlepeer-review


Context: Radiolabelled choline positron emission tomography has changed the management of prostate cancer patients. However, new emerging radiopharmaceutical agents, like radiolabelled prostate specific membrane antigen, and new promising hybrid imaging will begin new challenges in the diagnostic field. Objective: The continuous evolution in nuclear medicine has led to the improvement in the detection of recurrent prostate cancer (PCa), particularly distant metastases. New horizons have been opened for radiolabelled choline positron emission tomography (PET)/computed tomography (CT) as a guide for salvage therapy or for the assessment of systemic therapies. In addition, new tracers and imaging tools have been recently tested, providing important information for the management of PCa patients. Herein we discuss: (1) the available evidence in literature on radiolabelled choline PET and their recent indications, (2) the role of alternative radiopharmaceutical agents, and (3) the advantages of a recent hybrid imaging device (PET/magnetic resonance imaging) in PCa. Evidence acquisition: Data from recently published (2010-2015), original articles concerning the role of choline PET/CT, new emerging radiotracers, and a new imaging device are analysed. This review is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Evidence synthesis: In the restaging phase, the detection rate of choline PET varies between 4% and 97%, mainly depending on the site of recurrence and prostate-specific antigen levels. Both 68gallium (68Ga)-prostate specific membrane antigen and 18F-fluciclovine are shown to be more accurate in the detection of recurrent disease as compared with radiolabelled choline PET/CT. Particularly, Ga68-PSMA has a detection rate of 50% and 68%, respectively for prostate-specific antigen levels <0.5. ng/ml and 0.5-2. ng/ml. Moreover, 68Ga- PSMA PET/magnetic resonance imaging demonstrated a particularly higher accuracy in detecting PCa than PET/CT. New tracers, such as radiolabelled bombesin or urokinase-type plasminogen activator receptor, are promising, but few data in clinical practice are available today. Conclusions: Some limitations emerge from the published papers, both for radiolabelled choline PET/CT and also for new radiopharmaceutical agents. Efforts are still needed to enhance the impact of published data in the world of oncology, in particular when new radiopharmaceuticals are introduced into the clinical arena. Patient summary: In the present review, the authors summarise the last evidences in clinical practice for the assessment of prostate cancer, by using nuclear medicine modalities, like positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging. New indications for radiolabelled choline positron emission tomography/computed tomography have been developed in the last years. The utility of choline positron emission tomography/computed tomography in painting radiotherapy planning, in evaluating the response to treatments, and in monitoring the salvage treatments, has rapidly increased. Moreover, the last developments and researchers in new radiopharmaceutical agents have significantly improved the management of prostate cancer patients, particularly in recurrent status and for low prostate-specific antigen levels (

Original languageEnglish
Pages (from-to)161-75
Number of pages15
JournalEuropean Urology
Issue number1
Publication statusPublished - Jul 2016


  • Disease management
  • Prostate cancer
  • Radiopharmaceuticals
  • Recurrences
  • Therapies

ASJC Scopus subject areas

  • Urology

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