Health Problem: Prostate cancer is the most common cancer diagnosis and the second leading cause of cancer-related deaths in men in the United States. Within 10 years of successful treatment for localized prostate cancer, serum prostate specific antigen (PSA) levels will rise to detectable levels in approximately 15% to 40% of men. Most often, a rising PSA is an indication of prostate cancer recurrence, although uncommonly this phenomenon may be a benign PSA-only relapse due to residual normal prostate tissue after surgery or radiation.

Technology Description: Choline is a molecule involved in the synthesis of the structural components of cell membrane phospholipids. An increase in phospholipid synthesis (resulting in an increase in choline uptake) is an indicator for the enhanced cell proliferation and cell transformation seen in tumor cells and thus the presence of a lesion. In patients who have suspected recurrence of prostate cancer (e.g., due to rising levels of prostate specific antigen [PSA]), choline positron emission tomography (PET) or choline positron emission tomography-computed tomography (PET-CT) may help more accurately stage disease by identifying local, regional, and distant lesions that might have been missed with conventional diagnostic techniques. For choline PET or choline PET-CT, patients are injected intravenously with a radiotracer such as carbon-11-labeled choline (11C-choline) or fluorine-18-labeled choline (18F-choline). After a delay of 50 to 60 minutes to allow cellular uptake of the radiotracer, imaging is performed in the PET or PET-CT scanner. Decay of the radiotracer generates gamma rays that are detected by the scanner to pinpoint sites in the body that have accumulated radiotracer.

Controversy: Although choline PET and choline PET-CT are used in clinical practice, there are concerns regarding diagnostic accuracy, especially in men who have low PSA values. Since choline is used by all dividing cells, these tests may give false-positive results at sites in the body where there is active healing or multiplication of immune cells to fight infection.

Key Questions:

  • Do choline PET or choline PET-CT provide accurate diagnostic information in patients who have suspected relapse of prostate cancer?
  • Does information obtained from choline PET or choline PET-CT improve patient management or outcomes?
  • Are choline PET and choline PET-CT safe?
  • Have definitive patient selection criteria been established for choline PET or choline PET-CT?

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