Cholin-PET/CT zur Bildgebung des Prostatakarzinoms

Zusammenfassung

Die PET- und PET/CT-Diagnostik mit [¹¹C]- und [¹⁸F]-markierten Cholinderivaten wird zunehmend zur bildgebenden Diagnostik des Prostatakarzinoms eingesetzt. Die PET/CT mit radioaktiv markierten Cholinderivaten kann zum aktuellen Zeitpunkt für die Diagnose des primären Prostatakarzinoms nicht empfohlen werden. Die Cholin-PET/CT kann aber hilfreiche Informationen bei klinischem Verdacht auf Prostatakarzinom mit wiederholt negativen Biopsien in Vorbereitung auf eine gezielte Re-Biopsie liefern. Zunehmende Evidenz besteht für die Wertigkeit der PET und PET/CT mit radioaktiv markierten Cholinderivaten für das Re-Staging von Patienten mit einem biochemischen Rezidiv nach primärer lokaler Therapie. Erfolgversprechende Ergebnisse sind für diese Patientengruppe publiziert worden. Die Detektionsrate der Cholin-PET/CT zeigt eine lineare Abhängigkeit vom PSA-Serumwert. Für PSA-Serumwerte von kleiner 1 ng/ml können ca. ⅓ der Rezidive nachgewiesen werden. Durch eine Lokalisierung der Rezidiverkrankung bei diesen Patienten werden individualisierte Therapieansätze möglich. Präliminäre Studien zum Einsatz der [11C]Cholin-PET/CT zur Ermittlung des Therapieansprechens unter anti-hormoneller Therapie haben vielversprechende Ergebnisse erbracht. Klinische Multicenterstudien sind notwendig, um den Wert der Cholin-PET/CT für die Rezidivdiagnostik des Prostatakarzinoms weiter zu evaluieren und zu validieren, ebenso wie Leitlinien und Analysen zur Kosteneffizienz.

Abstract

PET and PET/CT using [¹¹C]- and [¹⁸F]-labelled choline derivatives are increasingly being used for imaging of prostate cancer. The value of PET and PET/CT with [¹¹C]- and [¹⁸F]-labelled choline derivates in biochemical recurrence of prostate cancer has been examined in many studies and demonstrates an increasing importance. Primary prostate cancer can be detected with moderate sensitivity using PET and PET/CT using [¹¹C]- and [¹⁸F]-labelled choline derivatives – the differentiation between benign prostatic hyperplasia, prostatitis or high-grade intraepithelial neoplasia (HGPIN) is not always possible. At the present time [¹¹C]choline PET/CT is not recommended in the primary setting but may be utilized in clinically suspected prostate cancer with repeatedly negative prostate biopsies, in preparation of a focused re-biopsy. Promising results have been obtained for the use of PET and PET/CT with [¹¹C]- and [¹⁸F]-labelled choline derivates in patients with biochemical recurrence. The detection rate of choline PET and PET/CT for local, regional, and distant recurrence in patients with a biochemical recurrence shows a linear correlation with PSA values at the time of imaging and reaches about 75% in patients with PSA >3 ng/mL. At PSA values below 1 ng/mL, the recurrence can be diagnosed with choline PET/CT in approximately 1/3 of the patients. PET and PET/CT with [¹¹C]- and [¹⁸F]choline derivates can be helpful for choosing a therapeutic strategy in the sense of an individualized treatment: since an early diagnosis of recurrence is crucial to the choice of optimal treatment. The localization of the site of recurrence – local recurrence, lymph node metastasis or systemic dissemination – has important influence on the therapy regimen.

Schlüsselwörter

Prostatakarzinom - PET/CT - PET - C-11 - F-18 - Cholin

Key words

prostate cancer - PET/ CT - choline

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