Off-line I have received a number of additional questions about the use of imaging with c11 choline (see my post at http://advancedprostatecancer.net/?p=3433). 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
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.
On the basis of a high PSA value (over 100) I have been advised that my prostate cancer has most surely already spread outside the prostate gland. It has probably been stopped for now by the near-by lymph nodes. My bone scan is still clean (as of Spring 2012).
Before consenting to radiation treatment I would like to know exactly where the cancer is and what tissue portions around the prostate gland should be irradiated.
Where in or near Northern California can I find 11-choline PET scan facilities?
Friedemann – I believe that with a PSA that is over 100 your cancer is most likely outside of the gland. However, why you think that it is limited only to the immediate area surrounding the gland? In my humble opinion your cancer is not just limited to the area immediate to the gland, but is probably already in other areas of your body.
To answer your question, the only place that you could get a choline PET scan is at the Mayo Clinic in Rochester, Minn.
I strongly urge that you forget the scan and immediately start hormone therapy starting with a Degradelix injection.
I am extremely interested in C11 choline .But I can not find
any patents about it ,could you tell me where i can find some
patent about it?
Thank you very much!
Ms. Hua – I suggest that you refer this question to the Mayo Clinic which is the only FDA approved site using this technology. – Joel
I am 7 years out from RP at MSKCC. PSa never went undetectable post surgery. Salvage radiation. ADT plus taxotere then IADT now continous ADT rising PSA. Had the 11C choline scan at Mayo 12-27-12. Scan showed mcrpc in 3 localized LN. Scheduled for salvage LN dissection on Jan 10, 2013. Thought some of your readers may be interested.
Bill, Good luck – Joel
I am 68 now i had prostate cancer in 2006 and i had seed implants followed with radiation .My PSA now is 4.3 and my doctor believes that it has come back even though my CT scan ,Bone scan ,Biopsy and MRI are clear.But my PSA is raising.Do you think i should have the choline sccan?My doctor wants to put me on hormone therapy ,he didn’t tell me anything about this scan i just came across it online.Do you think the pills work better or the injections for hormone therapy.How long do you think the hormones will work about my PSA was 7.3 first diagnose ,Score 3+3 ,Stage T2bc?What are the survival rates when someone begings chemotherapy?
Jimmy – You asked a pack of questions. 1- Without knowing your nadir score (the level your PSA became stable post treatment) I can not respond to your question about a recurrence. You certainly can have a recurrence even though your scans are clear. Given the fact that you stated your PSA is rising I would say that probably you are having a recurrence. 2- Hormone therapy is the normal next step, but given the recent approval of the scan it is certainly a very attractive possibility for you to consider. However, if you do decide to have the scan get it prior to starting hormone therapy as it will not yield good results with a PSA under 2.0. 2- It is impossible to predict how long hormone therapy will work. This is a very individual thing. If you read the literature it is predicted to last about 18 months, however our drugs are much better now and I believe that that figure is far from accurate. I have been on hormone therapy for almost 7 years and most men I know have had long term success like I have had. I know a few men who are now pushing the 15 year mark and hormone therapy continues to work for them. 3- The pills (Casodex) and the injections work differently. I am a firm believer in using both simultaneously. This is called ADT2 and I believe it is more effective than ADT1 (using just one). –
I suggest that you (or any survivor or caregiver) join our Advanced Prostate Cancer on-line group. Let me know if you wish to join us. – Joel
i will ask my doctor about my nadir score and i will get back to you with this.Where can i get the scan i asked at my hospital(radiation department)and they had no clue about what i was talking about?What i hope with this scan is to show the cancer and if it is possible to do radiation if it hasn’t gone where i have already received radiation in 2006.I am scared with the hormone therapy …side effects .You mentionedthat you have been on hormone therapy for 7 years what is your option?Has your quality of life changed …are you active as you used to?Do you think that it is best to be on hormone therapy always or have breaks in between?Start with piils or injections?Do these hormones affect your blood sugar,high blood presure?
Jimmy – The scans are available ONLY at the Mayo Clinic in Minn. Only a radiologist who knows your radiation history can tell you if it is possible for you to have additional radiation. To learn about the possible side effects of hormone therapy download my book (free) at the advanced prostate cancer section of the Malecare web site (www.malecare.org). Yes, being on ADT has changed my life, but any treatment we choose to have for cancer will have an effect. There is no way to predict what side effects you could experience and even if you are going to experience any of them. Your ability to have intermittent therapy depends on the nature of your cancer. This requires a consultation with a good,and experienced prostate cancer oncologist. I am a firm believer in ADT2, or both pills and injections. – Joel
i went to my doctor and my PSA from 4.3 in Nov. went now to 7.2. From today i am going to be on Casodex and Monday i am going to do a shot for one month (just to see how my body will react and then decide for 3 or 4 or 6 months).The shot is going to be Lupron.My doctor said that i should do pill and injection together ,exactly what you had mentiod in your 2 emails.He said that if my PSA drops low he will stop me from the pill and if i reach 0.1 or 0.2 he would take we off hormone therapy and when PSA starts going up put me again on HT.So it is going to be an off and on process depending on the PSA.The only thing that worries me is that i went to 2 other doctors in my area for a second opion and also talked to a nurse on the phone from American Cancer Society and all of them said that i should always stay on hormones(for as lond as they work) ,no breaks ….to accept it as a chronic medicine and that the survivor rates are higher by doing so.What is you opion?You mentioned you are on hormne therapy have you ever had perionds not being on hormones?Was hormone therapy your first treatment line for prostate? I didn’t do the C11 cholone scan ,i do not know if i would benefit as i have done seed implants follwed by radiation and my doctor believes that i have received enough radiation in that place ,as far as any kind of surgery i can not know that also do not know how reliable this scan is,so decided not to waste time …i just hope i did the right choice of going direclty to HT.Hope to hear from you soon.Thank for always getting back to me .
Hi Joel ,
Went to the doctor and my PSA from 4.3 in Nov is now 7.2.My doctor wants to put me on Casodex and lupron.What you had said in your 2 emails (firm believer in ADT2).I am thinking of doing the one month shot (then decided for 3,4