Evaluation of Prostate Cancer with 11C- and 18F-Choline PET/CT: Diagnosis and Initial Staging

Early diagnosis and adequate staging are crucial for the choice of adequate treatment in prostate cancer (PC). Morphologic and functional imaging modalities, such as CT and MRI, have had limited accuracy in the diagnosis and nodal staging of PC. Molecular PET/CT imaging with ¹¹C- or ¹⁸F-choline-labeled derivatives is increasingly being used, but its role in the diagnosis and initial staging of PC is controversial because of limitations in sensitivity and specificity for the detection of primary PC. For T staging, functional MRI is superior to ¹¹C- or ¹⁸F-choline PET/CT. For N staging, ¹¹C- or ¹⁸F-choline PET/CT can provide potentially useful information that may influence treatment planning. For the detection of bone metastases, ¹¹C- or ¹⁸F-choline PET/CT has had promising results; however, in terms of cost-effectiveness, the routine use of ¹¹C- or ¹⁸F-choline PET/CT is still debatable. ¹¹C- or ¹⁸F-choline PET/CT might be used in high-risk PC before radiation treatment planning, potentially affecting this planning (e.g., regarding dose escalation). This review provides an overview of the diagnostic accuracy and limitations of ¹¹C- or ¹⁸F-choline PET/CT in the diagnosis and staging of PC.