Off-line I have received a number of additional questions about the use of imaging with c11 choline (see my post at The questions ranged from what is c11 choline to how it compares to some of the other more sensitive PET scans contrasts that are being used to identify specific locations of recurrent advanced prostate cancer.

Choline is a naturally occurring B vitamin complex which is necessary for the health of the normal cell structure and signaling; neurotransmitters and for general cell metabolism.

C11 choline is a synthetic version choline that releases beta decay that can be visualized by Positron Emission Tomography, or a PET scan.

Choline is rapidly taken up by prostate cells (contrary to the general impression glucose, which is used in other scans, is not rapidly taken up by prostate cells) and will allow prostate cancer metastasis to be visual.

Since prostate cells metabolize the c11 choline the PET images will show metabolic activity, not structural abnormalities like old bone breaks or arthritis.

The goal of using this type of scan is to determine if a man’s rising PSA after receiving primary treatment is a sign that their cancer is systemic (in this case meaning that that it spread to multiple locations) or is still focal (or just spread to 1 or 2 spots). If the disease is focal there can be a discussion of a treatment approach that could specifically target these prostate cancer spots.

If you do decide to explore c11 choline scans remember that like other scans it does have a high rate of false positives, so any treatment plan should include confirmation that the “hot spots” are in fact advanced prostate cancer metastasis.

There are other non-FDA approved scan contrasts that are also being used in various places in the United States. They include

[18F]fluoroethylcholine-based PET/CT scans and Feraheme-based MRIs, however like the c11 choline scans they are not fool proof.

Unfortunately, current technology remains lacking. There is no imaging test today that has been shown to to have really high accuracy. Despite this, in some men, these scans are able to identify recurrent micro-metastasis in some men with early forms of prostate cancer recurrences.

Joel T Nowak, M.A., M.S.W.