Case of the Quarter - 2015 Q3

This case can be downloaded and read as an PDF or read on this page below. An interactive website with Hermes Medical Software that shows this case's PET and CT images can be seen by clicking the below button.

Clinical History

76-year-old male with a history of prostate cancer treated with radical prostatectomy in 2007. A biochemical recurrence in 2012 was treated with salvage radiotherapy and chemotherapy, and the patient subsequently commenced on hormone therapy.

In 2015, the patient developed upper abdominal discomfort and an ultrasound and contrast enhanced CT demonstrated a lesion in the right lobe of the liver. The case was discussed at the Prostate Cancer Multidisciplinary Meeting and a staging PET-CT scan with 18F-Choline was requested.


An 18F-Choline scan was acquired from skull base to upper thighs together with low dose CT scan for attenuation correction and image fusion.

There is a 4 cm low-attenuation lesion in the right lobe of the liver that shows peripheral increased choline activity with central photopenia. No other choline avid liver lesions are seen.

There is no abnormal uptake in the prostate bed and no choline avid pelvic or retroperitoneal lymph nodes. No other visceral or skeletal sites of abnormal choline activity are demonstrated.


Scan findings are in keeping with a solitary liver metastasis. There is no evidence of active metastatic disease elsewhere.

An image guided biopsy subsequently confirmed metastatic adenocarcinoma of the prostate.

Key Teaching points and Discussion


Wang H, Li B, Zhang P, Yao Y, Chang J. Clinical characteristics and prognostic factors of prostate cancer with liver metastases. Tumour Biol. 2014 Jan;35(1):595-601.

Pouessel D, Gallet B, Bibeau F, Avancès C, Iborra F, Sénesse P, et al. Liver metastases in prostate carcinoma: clinical characteristics and outcome. BJU Int. 2007;99:807-11.

KellyWK, Halabi S, CarducciMA, George DJ,Mahoney JF, Stadler WM, et al. Liver metastases (LM) to predict for short overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) patients (pts). J Clin Oncol. 2012;30(suppl; abstr 4655).

GarcÍa JR, Franquet E, Romera N, Moragas M, Jorcano S, Moragas G. Low diagnostic yield of the 11C-choline PET/CT in the detection of liver metastasis from prostate cancer. Rev Esp Med Nucl Imagen Mol. 2014 Jan-Feb;33(1):56-7.

Evidence-based Indications for the use of 18F- or 11C- Choline PET-CT in the United Kingdom 2013 - Prostate Cancer

Published by the RCP London, Glasgow, Edinburgh, RCR, BNMS, and ARSAC