Brain PET/CT using prostate cancer radiopharmaceutical agents in the evaluation of gliomas

Non-invasive imaging plays a crucial role in the management of patients with primary gliomas. Since their introduction in the clinical setting, 18F/11C-Choline and afterwards 18F/68Ga-PSMA and 18F-Fluciclovine gained widespread in the evaluation of prostate cancer. More recently, multiple reports and original studies documented the utility of these prostate cancer positron emission tomography (pcPET) radiotracers in the assessment of gliomas. To evaluate the potential role of pcPET radiotracers currently used in brain tumors, we present a review of these radiotracers in the different settings of the diagnostic work-up of patients with gliomas. A literature search regarding articles published from 2000 to July 2020 regarding the use of pcPET radiotracers in gliomas was performed in the PubMed and Scopus databases, using combinations of search strings including the following words and acronyms: “choline”, “CHO”, “prostatic specific membrane antigen”, “PSMA”, “Fluciclovine”, FACBC, “Positron Emission Tomography”, “PET”, “brain tumor”, “glioma”, “glioblastoma”. A total of 27 articles about pcPET radiotracers (Choline N = 14, PSMA N = 7; Fluciclovine N = 6) evaluating every phase of disease in glioma (diagnosis, grading and prognosis, evaluation of recurrence, treatment planning and response to therapy assessment) were discussed. pcPET tracers present potential utility in the differential diagnosis, estimation of prognosis, evaluation of recurrence and treatment planning in patients with glioma. These radiotracers may hold a complementary role in conjunction with advanced MRI techniques in the non-invasive grading of gliomas.