F-18-Fluorocholine PET/CT and MR Imaging/ Spectroscopy in the Management of Primary and Recurrent Prostate Cancer
F-18-Fluorocholine PET/CT and MR Imaging/ Spectroscopy in the Management of Primary and Recurrent Prostate Cancer
The purpose of this study is to demonstrate that realization of guided biopsies by multimodal
 imaging with 18F-fluorocholine PET / CT and MR Imaging/spectroscopy would allow to increase
 the rate of detection prostate cancer compared with the current approach and give an
 information about location and tumoral volume before surgery.:
1. To evaluate the utility of F-18-FCH-PET/CT and MR imaging with 3-D MR spectroscopy in
 detecting, localizing, and estimating the volume of initial primary prostate cancer as
 compared to the current standard work-up using TRUS-guided biopsy. All imaging findings
 will be correlated with "gold standard" step slice histological examination. The
 hypothesis is that the combination of noninvasive imaging will improve the preoperative
 work-up as compared to the current approach.

 2. To evaluate FCH-PET for the restaging of prostate cancer after biochemical relapse in a
 large patient cohort. This will run in parallel to the work-up of primary prostate
 cancer, as the FCH radiopharmaceutical will be available during the time of study at
 absolutely no cost to patients or CHUV. A number of studies have demonstrated the
 benefits of F-18-FCH-PET/CT for these patients and this indication is currently not
 reimbursed by Swiss obligatory health insurance providers.
PRIMARY PROSTATE CANCER

 Inclusion Criteria:

 -  Age ≤ 80 years

 -  Karnofsky index ≥ 80

 -  First prostate biopsy

 -  Presence of at least one of the following:

 -  Total PSA 10 ng/mL

 -  Total PSA 2.5-10 ng/mL with free-PSA <20% and/or PSA velocity 0.75 ng/mL/year

 -  Suspicious hypoechoic lesion at TRUS and/or suspicious finding at digital rec¬tal
 examination

 -  Informed signed consent.

 Exclusion Criteria:

 -  Impaired capacity to consent

 -  Coexistence of clinically-proven prostate cancer

 -  Neoadjuvant hormonal treatment (including 5-α reductase inhibitors)

 -  Contraindications to surgery

 -  Contraindications to MR Imaging (see below)

 PROSTATE CANCER RELAPSE

 Inclusion Criteria:

 -  Age ≤ 90 years

 -  Karnofsky index ≥ 80

 -  Previous treatment for prostate cancer

 -  No clinical recurrence based on standard work-up (abdominal / pelvic CT, MRI, and bone
 scintigraphy)

 -  Biochemically proven relapse of prostate cancer (PSA > 0.2 ng/mL after prostatectomy,
 nadir PSA+2 ng/mL (Phoenix definition) or ≤ 3 successive rising PSA levels (ASTRO
 definition) after curative radiotherapy).

 -  Informed signed consent.

 Exclusion Criteria:

 -  Coexistence of another clinically-proven cancer

 -  Contraindications to surgery or radiation therapy treatment