PMC8077372_01
A 64-year-old man with castration-resistant prostate cancer treated with abiraterone. a The first 11C-choline PET/CT before abiraterone therapy showed multiple osteoblastic lesions in the spine, pelvis, and ribs with no 11C-choline uptake, reflecting treatment-induced sclerosis during the treatment course, as well as several instances of abnormal 11C-choline uptake in the thoracic and lumbar spine sclerosis, suggesting viable tumors. b The second 11C-choline PET/CT 6 months after starting abiraterone showed disappearance of the abnormal 11C-choline uptake seen on the first 11C-choline PET/CT (a) and no new lesions at other sites, suggesting nonviable bone metastases. We can assume a complete metabolic response according to the two 11C-choline PET/CT scans.
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F1
However, in the latest half-year, the PSA value gradually increased by 0.006 ng/mL to 0.041 ng/mL, and the patient underwent a first 11C-choline PET/CT examination to evaluate his current disease status. 11C-choline PET/CT showed multiple osteoblastic lesions in the spine, pelvis, and ribs with no 11C-choline uptake, reflecting treatment-induced sclerosis during the treatment course, as well as several instances of abnormal 11C-choline uptake in the thoracic and lumbar spine sclerosis, suggesting viable tumors (Fig. 1a). The second 11C-choline PET/CT 6 months after starting abiraterone showed disappearance of the abnormal 11C-choline uptake seen on the first 11C-choline PET/CT and no new lesions at other sites, suggesting nonviable bone metastases (Fig. 1b).
PMC8077372_02
. A 69-year-old man with castration-resistant prostate cancer was treated with radium-223 therapy. a The first 11C-choline PET/CT showed multiple osteoblastic lesions and abnormal 11C-choline uptake in the spine and pelvis, suggesting viable tumors. b The second 11C-choline PET/CT at the end of the radium-223 therapy showed a decrease in existing 11C-choline uptake, but multiple new appearances of osteoblastic and nonosteoblastic lesions with abnormal 11C-choline uptake in the spine, pelvis, ribs, and femur, suggesting multiple viable bone metastases. We can assume progressive metabolic disease according to the two 11C-choline PET/CT scans.
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F2
However, the PSA value gradually increased to 18.7 ng/mL and he underwent a first 11C-choline PET/CT examination to evaluate his current disease status. 11C-choline PET/CT showed multiple osteoblastic lesions and abnormal 11C-choline uptake in the spine and pelvis, suggesting viable tumors (Fig. 2a). The second 11C-choline PET/CT at the end of the radium-223 therapy showed a decrease in existing 11C-choline uptake, but multiple new appearances of osteoblastic and nonosteoblastic lesions with abnormal 11C-choline uptake in the spine, pelvis, ribs, and femur, suggesting multiple viable bone metastases (Fig. 2b).