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Choline PET or PET/CT and Biochemical Relapse of Prostate Cancer: A Systematic Review and Meta-Analysis

Evangelista, Laura MD, PhD*; Zattoni, Fabio MD; Guttilla, Andrea MD; Saladini, Giorgio MD*; Zattoni, Filiberto MD; Colletti, Patrick M. MD; Rubello, Domenico MD§

doi: 10.1097/RLU.0b013e3182867f3c
Review Article

Aim The increase of prostate-specific antigen (PSA) after radical retropubic prostatectomy (RP) or external beam radiotherapy (EBRT) is the most sensitive tool for detecting prostate cancer (PCa) recurrence, although this measure cannot distinguish between local, regional, or distant recurrence. The aim of this meta-analysis was to evaluate the diagnostic performance of 18F-choline and 11C-choline PET or PET/CT in detection of locoregional or distant metastases in PCa.

Materials and Methods Medline, Web of Knowledge, and Google Scholar search was carried out in order to select English-language articles dealing with diagnostic performance of both 18F-choline and 11C-choline PET for the detection of PCa recurrence after RP or EBRT. Articles were included only if absolute numbers of true-positive, true-negative, false-positive, and false-negative test results were available or derivable from the text and regarded local, lymph node, and distant metastases. Reviews, clinical reports, and editorial articles were excluded. All complete studies were re-analyzed thus performing a quantitative analysis.

Results From the years 2000 to 2012, we found 53 complete articles that critically evaluated the role of choline PET in restaging patients with PCa recurrence. The meta-analysis was carried out and dealt with 19 selected studies (12 studies for all sites of disease, 3 for lymph node metastases, and 4 for local recurrence), with a total of 1555 patients. The meta-analysis provided a pooled sensitivity of 85.6% (95% CI: 82.9%–88.1%) and pooled specificity of 92.6% (95% CI: 90.1%–94.6%) for all sites of disease (prostatic fossa, lymph nodes, and bone), a pooled sensitivity of 75.4% (95% CI: 66.9%–82.6%) and pooled specificity of 82% (95% CI: 68.6%–91.4%) for prostatic fossa recurrence, and a pooled sensitivity of 100% (95% CI: 90.5%–100%) and pooled specificity of 81.8% (95% CI: 48.2%–97.7%) for lymph node metastases. The heterogeneity ranged between 0.00% and 88.6%. The diagnostic odds ratios were 62.123 (95% CI: 24.783–155.72), 5.869 (95% CI: 1.818–18.946), and 138.57 (95% CI: 11.27–1703.8), respectively, for all sites of disease, local recurrence, and lymph node disease.

Conclusions Choline PET and PET/CT represent high sensitivity and specificity techniques for the detection of locoregional and distant metastases in PCa patients with recurrence of disease. Moreover, a high diagnostic odds ratio was found for the identification of lymph node disease in patients with biochemical recurrence of PCa.

From the *Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto IOV—IRCCS, Padua, Italy; †Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy; ‡Department of Radiology, University of Southern California, Los Angeles, California; and §Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.

Received for publication November 26, 2012; and revision accepted December 17, 212.

Conflicts of interest and sources of funding: none declared.

Reprints: Domenico Rubello, MD, Department of Nuclear Medicine, Medial Physics, Radiology, Neuroradiology, Head Service of Nuclear Medicine & PET/CT Centre, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy. E-mail:

© 2013 by Lippincott Williams & Wilkins