Prostate biopsy guided by 18F-fluorocholine PET in men with persistently elevated PSA levels

Excerpt

We read with interest the paper published in the May 2008 issue of the European Journal of Nuclear Medicine by Igerc et al. titled “The value of ¹⁸F-Choline PET/CT in patients with elevated PSA-level and negative prostate needle biopsy for localization of prostate cancer” [1]. In this study, the authors performed fluorocholine positron emission tomography (PET)/computed tomography (CT) of the prostate in 20 patients who have had repeatedly negative prostate biopsies despite persistently elevated prostate specific antigen (PSA) levels. The PET/CT images were interpreted by the authors in a semi-quantitative fashion by measurement of prostatic maximum standardized uptake value (SUVmax) as well as in a subjective fashion, by visually classifying the pattern of prostatic uptake as focal, multifocal, or inhomogeneous. To investigate the source of these patterns of prostatic uptake, the authors used the results of subsequent prostate biopsy as the study gold standard. In addition to sextant-based biopsy, the authors directed additional prostate biopsies towards areas corresponding to increased fluorocholine uptake on PET/CT. We congratulate the authors on their work, as it represents the first study of fluorocholine PET/CT in men who have not yet been diagnosed with prostate cancer, but are at increased risk of having the disease in view of having persistently elevated levels of PSA. …