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To assess the significance of incidental F-18 choline uptake in prostate cancer patients in regions not characteristic for metastatic spread of the disease. Subjects and Methods: Two hundred and twenty-one prostate cancer patients were scanned with F-18 choline PET/CT. Mean age of our patient population was 70 years, and mean PSA value was 10, 8 ng/ml. Mean administered activity was 200 MBq of F-18 choline (IASOCholine, IASON GmBH). Additional findings uncharacteristic for metastatic spread of prostate cancer were reported and prospectively analyzed based on histopathological, clinical or radiological follow-up. The mean follow-up period was 23 months (range 9 to 44 months). Results: One hundred and fifty- four patients had a positive finding on the F-18 choline PET/CT characteristic for prostate cancer metastases (70%). Regional lymph node metastases were found in 110 patients (49%), and bone metastases were found in 71 patient (32%). A second malignancy was discovered in 15 patients due to F-18 choline uptake. Histopathology of focal intense FCH uptake in the thyroid reported two papillary thyroid carcinoma and one follicular thyroid carcinoma. Mesothelioma was found in one patient, reporting a SUVmax value of 4, and in another, a hepatocellular carcinoma was detected. One patient had a previously unknown chronic lymphocytic leukemia. Several patients had an increased uptake in suprarenal adenomas and in one a suprarenal gland carcinoma was detected. Focal uptake of FCH was found in lung nodules in multiple patients, and further invasive procedures reported primary lung cancer in five patients. Histopathology indicated three squamous cell carcinomas, one adenocarcinoma, and one bronchioalveolar carcinoma. Metastases of other malignancies were found in three patients (renal and colon cancer). Other nonspecific F-18-choline uptake included low metabolism in lymph nodes of the mediastinum, axillary and inguinal regions, reported in 84 patients (38%), with a mean SUVmax value of 4, 7, 3, 7 and 4, 1, respectively. Ultrasound and biopsy in the follow-up period reported granulomatous inflammation in these patients. Conclusion: Functional imaging with F-18 choline PET/CT provides additional information on various cancer cells metabolism and activity. It has an important impact on therapeutic strategy, providing physicians with clinical certainty for the appropriate and individual patient management. |
