Evidence note 67

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Karen Macpherson

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Susan Myles

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Shonagh Ramsey

Evidence note 67

What is the most clinically effective and cost effective non-FDG tracer for use in PET-CT for staging and assessment of patients with suspected recurrent prostate cancer?

Key points

  • Several non-FDG tracers are available for use with PET-CT in the context of restaging suspected recurrence in patients previously treated for prostate cancer, including 11C-choline, 18F-fluoroethylcholine, 18F-fluoromethylcholine, anti-18F-FACBC, and 68Ga-PSMA.
  • There is evidence for high sensitivity and specificity of choline-based tracers in detecting prostate cancer recurrence.
  • 18F-choline appears to be more effective than 11C-choline in restaging prostate cancer.
  • Based on a small number of studies, the novel tracer 68Ga-PSMA had a high detection rate for recurrent prostate cancer and was more effective than choline tracers, particularly at low PSA levels.
  • A single primary study comparing the novel tracer anti-18F-FACBC with choline reported higher detection rates with anti-18F-FACBC in patients with suspected prostate cancer recurrence.
  • A systematic review demonstrated superior detection rates for 68Ga-PSMA compared with choline and anti-18F-FACBC tracers in patients with suspected prostate cancer recurrence.
  • There is limited evidence to recommend replacing choline tracers with 68Ga-PSMA or anti-18F-FACBC for detection of recurrent prostate cancer. Studies suggest that 68Ga-PSMA is more accurate in detecting recurrent disease compared with radioactive labelled choline.


The content of this evidence note was accurate and based upon the most up to date evidence available at the date of first publication. Readers are asked to consider that new trials and technologies may have emerged since first publication and the evidence presented may no longer be current.

This evidence note will be considered for review 2 years post-publication, and at 2-yearly intervals thereafter.

Published Date: 28 April 2017