Molecular imaging of cholinergic processes in prostate cancer using ¹¹C-donepezil and ¹⁸F-FEOBV

High-grade prostate cancer (PC) displays parasympathetic neoneurogenesis. We investigated the binding of two PET tracers that visualize cholinergic nerves in PC tissue using autoradiography.

Prostatectomy tissue was subjected to autoradiography with (11)C-donepezil and (18)F-FEOBV and correlated with Gleason scores (GS). Regions of interest on the autoradiograms were defined and quantified. Tracer binding in cancer tissue regions was compared with that in normal tissue.

We included 13 patients with biopsy-verified PC. In particular, (11)C-donepezil uptake was higher in "high-grade" PC (GS ≥4 + 3) than in "low-grade" PC and benign hyperplasia. (11)C-donepezil uptake ranged from a mean of 56 % higher (GS 3 + 3) to 409 % higher (GS 4 + 4), and (18)F-FEOBV uptake ranged from 67 % higher (GS 3 + 3) to 194 % higher (GS 4 + 5). The uptake of both tracers was higher in PC with a high GS than in PC with a low GS, but the difference was significant only for (11)C-donepezil (p = 0.003).

Uptake of PET tracers binding to cholinergic nerves was markedly higher in PC with a high GS than in PC with a low GS. This finding implies that (11)C-donepezil PET/CT may be able to differentiate between low-grade and high-grade PC.