Choline C-11 PET scan is an imaging test used to help detect sites of prostate cancer that have returned despite treatment (recurrent prostate cancer). It may be used when other imaging has not been helpful. Choline C-11 PET scan is a positron emission tomography (PET) scan that uses a special chemical tracer called Choline C-11 Injection. At Mayo Clinic, a low-dose computerized tomography (CT) scan is done at the same time to help further show internal anatomy.
Choline C-11 PET scan may help doctors detect possible sites of recurrent prostate cancer that more-conventional imaging tests can't identify. Locating recurrent prostate cancer sooner may allow your doctor to identify small, isolated deposits of cancer — within the prostate and outside of the prostate — that can be targeted for more-effective treatment.
Choline C-11 PET scan uses a radioactive form of the vitamin choline. A small amount of the tracer is injected into a vein in your arm just before the scan is done. Prostate cancer cells in your body readily absorb the tracer. This can help doctors detect areas of prostate cancer cells throughout your body. A biopsy to remove some cells for lab testing is then done to confirm the presence of recurrent prostate cancer.
Read more about positron emission tomography scan and prostate cancer.
Earlier detection of recurrent prostate cancer sooner. Choline C-11 PET scan can help doctors detect recurrent prostate cancer before it may be detected by more-conventional imaging tests.
In men with rising prostate-specific antigen (PSA) levels, this test may help detect sites of possible recurrent prostate cancer at PSA levels as low as 2 nanograms per milliliter (ng/mL). Conventional tests may not detect a recurrence until PSA levels are greater than 20 ng/mL. This could mean detecting sites of cancer recurrence months or years in advance.
- FDA-approved Choline C-11 PET scan site. Mayo Clinic's campus in Rochester, Minnesota, is the first, and currently the only, medical center in the United States to receive approval by the Food and Drug Administration (FDA) to prepare and administer the Choline C-11 PET scan imaging agent (Choline C-11 Injection). Mayo Clinic in Rochester is currently the only site in the United States using the FDA-approved imaging agent.
- Helps identify areas of active recurrent prostate cancer after all forms of treatment. Previous treatment may leave scar tissue that can be confused with active cancer when viewed using conventional imaging. Choline C-11 PET scan can help doctors distinguish between scar tissue, inactive cancer cells and active, recurrent prostate cancer.
- Team approach. At Mayo Clinic, an expert team of urologists, medical oncologists, radiation oncologists and other specialists, if needed, work together to provide the best care possible. Mayo Clinic specialists have extensive experience treating men with complex cases of recurrent prostate cancer.
- Full range of treatments available. If Mayo Clinic doctors diagnose recurrent prostate cancer, you have many treatment options. These options may include radiation therapy, including highly focused stereotactic body radiation therapy, intensity-modulated radiation therapy and brachytherapy; hormone therapy; immunotherapy; surgery to remove the prostate (prostatectomy) and, if necessary, pelvic lymph nodes; cryosurgery; and chemotherapy.
- Comprehensive cancer center. Mayo Clinic Cancer Center meets strict standards for a National Cancer Institute comprehensive cancer center, which recognizes scientific excellence and a multidisciplinary approach to cancer prevention, diagnosis and treatment.
Mayo Clinic in Rochester, Minn., and Mayo Clinic in Scottsdale, Ariz., are ranked among the Best Hospitals for cancer by U.S. News & World Report. Mayo Clinic in Jacksonville, Fla., is ranked high performing for cancer by U.S. News & World Report.
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For Choline C-11 PET scan for recurrent prostate cancer, you first meet with your doctor to determine whether the exam is appropriate for you. If it's determined that you're a candidate, you'll receive a full-body positron emission tomography (PET) scan using Choline C-11 Injection. At Mayo Clinic, you will also receive a computerized tomography (CT) scan at the same time.
The entire scanning procedure — including preparation time — takes about an hour. To prepare, you'll be asked to lie on your back on a movable table. You'll likely be strapped onto the table to help keep you from moving during the scan. You can wear your street clothes and small jewelry. Just before the PET and CT scans, you'll receive the Choline C-11 agent through an injection in a vein in your arm. The table on which you're lying will then move into the scanner and the exam will begin. The actual Choline C-11 PET scan and accompanying CT scan usually take about 20 minutes. After 20 minutes, the Choline C-11 agent degrades and is no longer useful in identifying sites of possible recurrent prostate cancer. During the scan, you may listen to music to help you relax.
When the scan is complete, the table moves out of the scanner, and you'll be free to leave. You can resume your daily activities. Your doctor will meet with you to discuss the results of your scan.
Possible risks associated with the Choline C-11 PET scan include imaging errors, allergic reaction to the imaging agent and mild injection site reactions. A Choline C-11 PET scan also contributes to your long-term cumulative radiation exposure.
Read the full prescribing information for Choline C-11 Injection.
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
For details about requesting an appointment for Choline C-11 PET scan in conjunction with evaluation for recurrent prostate cancer, please call 507-293-0933 from 8 a.m. to 5 p.m. Central time, Monday through Friday.
You must complete an initial evaluation in the Department of Urology before being considered for the Choline C-11 PET scan. Following the consult, a determination will be made regarding the appropriateness of the scan. If the Choline C-11 PET scan is recommended, a separate return visit will likely be required to conduct the scan. Access for this scan is limited by the ability to produce the Choline C-11 imaging agent and appointment availability.
The local contractor for the Centers for Medicare and Medicaid Services (CMS) has approved coverage of this scan for the indications of recurrent prostate cancer and biochemical recurrence of prostate cancer.
For all other appointment information at Mayo Clinic's campus in Rochester, see Appointments at Mayo Clinic in Rochester.
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Aug. 05, 2014
- FDA approves production of imaging agent that helps detect prostate cancer. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm319201.htm. Accessed April 15, 2014.
- Choline C-11 injection (prescribing information). Rochester, Minn. Mayo Clinic PET Radiochemistry Facility; 2012. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#labelinfo. Accessed April 15, 2014.
- Prostate cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed April 15, 2014.
- Murphy RC, et al. The utility of 11C-Choline PET/CT for imaging prostate cancer: A pictorial guide. American Journal of Roentgenology. 2011;196:1390.
- Fuccio C, et al. Choline PET/CT for prostate cancer: Main clinical applications. European Journal of Radiology. 2011;80:50.
- Fox JJ, et al. Molecular imaging of prostate cancer. Current Opinion in Urology. 2012;22:320.
- Kitajima K, et al. Update on positron emission tomography for imaging of prostate cancer. International Journal of Urology. 2014;21:12.
- Mitchell CR, et al. Operational characteristics of 11C-Choline positron emission tomography/computerized tomography for prostate cancer with biochemical recurrence after initial treatment. The Journal of Urology. 2013;189:1308.
- Kwon ED (expert opinion). Mayo Clinic, Rochester, Minn. April 16, 2014.