Prostate cancer:: a comparative study of 11C-choline PET and MR imaging combined with proton MR spectroscopy

Purpose: Prostate cancer is difficult to visualise in its early stages using current imaging technology. The present study aimed to clarify the utility of C-11-choline PET for localising and evaluating cancer lesions in patients with prostate cancer by conducting a prospective comparison with magnetic resonance (MR) imaging combined with proton MR spectroscopy. Methods: PET and MR imaging combined with proton MR spectroscopy were performed in 20 patients with prostate cancer. Correlations among the metabolite ratio of choline + creatine to citrate (Cho+Cr/Ci) on MR spectroscopy, serum PSA and maximum standardised uptake value (SUVmax) of C-11-choline were assessed. The location of the primary lesion was assessed by the site of SUVmax and the laterality of the highest Cho+Cr/Ci ratio and confirmed by examination of surgical pathology specimens (n = 16). Results: PET exhibited a diagnostic sensitivity of 100% (20/20) for primary lesions, while the sensitivities of MR imaging and MR spectroscopy were 60% (12/20) and 65% (13/20), respectively. Weak linear correlations were observed between SUVmax and serum PSA (r = 0.52, p< 0.05), and between SUVmax and Cho+Cr/Ci ratio (r = 0.49, p< 0.05). Regarding the localisation of main primary lesions, PET results agreed with pathological findings in 13 patients (81%) (kappa = 0.59), while MR spectroscopy results were in accordance with pathological findings in eight patients (50%)(kappa = 0.11). Conclusion: This preliminary study suggests that C-11-choline PET may provide more accurate information regarding the localisation of main primary prostate cancer lesions than MR imaging/MR spectroscopy. A further clinical study of C-11-choline PET in a large number of patients suspected of prostate cancer will be necessary to determine the clinical utility of C-11-choline PET in patients who clinically require biopsy.