The Role of 11C-Choline and 18F-Fluorocholine Positron Emission Tomography (PET) and PET/CT in Prostate Cancer: A Systematic Review and Meta-analysis

ContextThe role of positron emission tomography (PET) and PET/computed tomography (PET/CT) in prostate cancer (PCa) imaging is still debated, although guidelines for their use have emerged over the last few years.ObjectiveTo systematically review and conduct a meta-analysis of the available evidence of PET and PET/CT using 11C-choline and 18F-fluorocholine as tracers in imaging PCa patients in staging and restaging settings.Evidence acquisitionPubMed, Embase, and Web of Science (by citation of reference) were searched. Reference lists of review articles and included articles were checked to complement electronic searches.Evidence synthesisIn staging patients with proven but untreated PCa, the results of the meta-analysis on a per-patient basis (10 studies, n = 637) showed pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of 84% (95% confidence interval [CI], 68–93%), 79% (95% CI, 53–93%), and 20.4 (95% CI, 9.9–42.0), respectively. The positive and negative likelihood ratios were 4.02 (95% CI, 1.73–9.31) and 0.20 (95% CI, 0.11–0.37), respectively. On a per-lesion basis (11 studies, n = 5117), these values were 66% (95% CI, 56–75%), 92% (95% CI, 78–97%), and 22.7 (95% CI, 8.9–58.0), respectively, for pooled sensitivity, specificity, and DOR; and 8.29 (95% CI, 3.05–22.54) and 0.36 (95% CI, 0.29–0.46), respectively, for positive and negative likelihood ratios. In restaging patients with biochemical failure after local treatment with curative intent, the meta-analysis results on a per-patient basis (12 studies, n = 1055) showed pooled sensitivity, specificity, and DOR of 85% (95% CI, 79–89%), 88% (95% CI, 73–95%), and 41.4 (95% CI, 19.7–86.8), respectively; the positive and negative likelihood ratios were 7.06 (95% CI, 3.06–16.27) and 0.17 (95% CI, 0.13–0.22), respectively.ConclusionsPET and PET/CT imaging with 11C-choline and 18F-fluorocholine in restaging of patients with biochemical failure after local treatment for PCa might help guide further treatment decisions. In staging of patients with proven but untreated, high-risk PCa, there is limited but promising evidence warranting further studies. However, the current evidence shows crucial limitations in terms of its applicability in common clinical scenarios.