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Updated: Jul 16, 2026
07:02
A Computerized Test Battery to Study Pharmacodynamic Effects on the Central Nervous System of Cholinergic Drugs in Early Phase Drug Development
Published on: February 11, 2019
Choline PET/CT in the PSMA Era: Clinical Repositioning, Biological Perspectives, and Emerging Applications
Virginia Rossetti1, Lorenzo Fantini1, Irene Marini1
1Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", 47014 Meldola, Italy.
Diagnostics (Basel, Switzerland)
|July 15, 2026
Summary
Choline PET/CT is not obsolete in the prostate-specific membrane antigen (PSMA) era. While PSMA PET/CT dominates prostate cancer imaging, choline PET/CT offers complementary roles in specific scenarios and is established for primary hyperparathyroidism.
Area of Science:
- Nuclear Medicine
- Oncology
- Endocrinology
Background:
- Prostate-specific membrane antigen (PSMA)-targeted PET/CT has largely replaced radiolabeled choline tracers in prostate cancer imaging.
- This shift represents an evolution towards receptor-targeted, biology-driven imaging strategies.
Purpose of the Study:
- To critically review the current and emerging roles of choline PET/CT in the PSMA era.
- To assess its utility in prostate cancer and other clinical applications, focusing on biological rationale and evidence.
Main Methods:
- Narrative review of existing literature.
- Analysis of biological rationale for choline uptake.
- Evaluation of clinical data for prostate cancer and extra-prostatic applications.
Main Results:
- PSMA PET/CT is the primary modality for prostate cancer, especially biochemical recurrence.
- Choline PET/CT may offer complementary metabolic information in select prostate cancer cases (e.g., PSMA-low disease, aggressive variants) but requires further validation.
- 18F-fluorocholine PET/CT is clinically established for primary hyperparathyroidism, outperforming conventional imaging.
- Applications in hepatocellular carcinoma and neuro-oncology are exploratory.
Conclusions:
- Choline PET/CT retains a selective role, not obsolete in the PSMA era.
- Its strongest current evidence supports primary hyperparathyroidism.
- Other applications necessitate cautious interpretation and further prospective studies.
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