In biochemical recurrence after curative treatment
of prostate cancer, Choline PET/CT
1- has a detection rate of 10-20% when PSA: 1-2
ng/ml
2- has a detection rate of 81% when PSA dt is less
than 3 months
3- it best identifies patients with bone metastases
4- PET/CT is indicated for pre-op staging in case of
suspicious MRI
• 2-A negative Choline PET/CT
•
is not sufficient to rule out the indication
for lymph-adenectomy
• a-true
• b-false
• A 67 year old man has a T2b prostate cancer
Gleason score 8, PSA: 8.7ng/ml. mpMRI shows
extracapsular extension on the right , no enlarged
lymph nodes
1- a bone scan is necessary
2- bone scan is more accurate for osteoclastic
lesions
3- mp MRI of the prostate can detect all bone
metastases
4- DW total body MRI is more sensitive than bone
scan to R/O bone metastases
• The use of choline PET/CT for preoperative LN
staging:
1- is indicated
2- high sensitivity but poor specificity
3- should be limited to patients with very
high risk for LN positive status according to
nomograms
4- has a low positive predicted value
PET choline for detection of LN and distant recurrence in PC
patients with biochemical recurrence
1- Significantly high detection rate with PSA <1 ng/ml
2- The Trigger PSA value is = or > 5g/ml
3- No relationship between detection rate and PSA kinetics
4- A crucial role as first diagnostic procedure in patients who
demonstrate a fast growing PSA kinetics and low Trigger PSA
choline PET/CT
1- could play a crucial role as first diagnostic
procedure in PC patients
2- It is not recommended for initial diagnosis
and staging as a first-line method
3- PSA dt could not be considered as an
independent predictor of positive choline
PET/CT
4- 18f choline PET/CT is not accurate to detect
distant recurrence
Dynamic Contrast Study
1. Based on density of tumor cells
2. Early enhancement of tumoral tissue in T2weighted MRI
3. Delayed wash out of contrast agent are seen
in prostate cancer
4. Early enhancement of tumoral tissue in T1 weighted MRI
Diffusion Weighted Imaging
1. Works based on angiogenesis
2. Water molecules movement increases in a high
cellular environment
3. Sensitivity and specificity of DWI when added
to T2-Weighted MRI for detecting prostate
cancer is about 84% and 87% respectively
4. DW-MR imaging alone shows high sensitivity in
cancer recurrence detection after radiotherapy
MR Spectroscopy
1. Combination of choline and fluorocholine is
measured in MRS
2. Citrate accumulates in the T zone
3. Citrate is higher in malignant prostatic tissue
4. A higher ratio of Cho+Cr/Ci (more than 0.75 ) is
in favor of high risk of malignancy
Regarding the use of Multiparametric MR imaging
select the wrong answer
• Detection and local staging of prostate cancer
• Follow-up of patients after radical
prostatectomy or radiation therapy
• Detection of skeletal metastasis
• Targeting biopsies in patients suspicious of
prostate cancer