Predictive factors of [18F]-Choline PET/CT in 170 patients with increasing PSA after primary radical treatment

J Cancer Res Clin Oncol. 2013 Mar;139(3):521-8. doi: 10.1007/s00432-012-1354-4. Epub 2012 Nov 27.


Aim: The purpose of this study was to evaluate the potential usefulness of [18F]-Choline PET/CT in the restaging of prostate cancer patients, who presented a rising PSA.

Materials and methods: We evaluated 170 prostate cancer patients, previously radically treated, that were referred for restaging with [18F]-Choline PET/CT.

Results: A total of 129 patients (median PSA 4.29 ng/ml at relapse) showed one or more areas of high uptake on PET/CT scan, while 41 patients with a median PSA of 1.07 ng/ml at relapse showed negative PET/CT scans. No false negative was found, while 31 patients were identified as false positive. Specificity of Choline PET/CT in our series was 56.9 %, while sensibility was 100 %. At the time of restaging, a PSA value superior or equal to 1 ng/ml was found to be a statistically significant predictive factor of PET positivity, either at the univariate (p < 0.0001) and at the multivariate analysis (p < 0.0001).

Conclusions: Based on our findings, [18F]-Choline PET/CT is confirmed as a useful diagnostic tool to detect early recurrence, in patients with increasing PSA after primary treatment. However, in case of a mild increase in PSA, positive results must be validated with other techniques, as specificity and positive predictive value of [18F]-Choline PET/CT decrease with the lower values of PSA.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Carcinoma / blood
  • Carcinoma / diagnostic imaging*
  • Carcinoma / mortality
  • Carcinoma / surgery*
  • Choline*
  • Cohort Studies
  • Fluorine Radioisotopes
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging / methods
  • Neoadjuvant Therapy
  • Positron-Emission Tomography
  • Predictive Value of Tests
  • Prognosis
  • Prostate-Specific Antigen / analysis
  • Prostate-Specific Antigen / blood*
  • Prostatectomy
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnostic imaging*
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / surgery*
  • Retrospective Studies
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Up-Regulation


  • Fluorine Radioisotopes
  • Prostate-Specific Antigen
  • Choline