Choline C 11 (Intravenous)

Used to highlight cancer cells, Choline C 11 is routinely administered before positron emission tomography (PET ) scanning.

Overview

If doctors suspect that a patient has cancer, they will arrange for them to have specific diagnostic tests. MRI, CT and bone scans are all used to diagnose cancer in the body but they may be unable to highlight the presence of some cancer cells. Positron emission tomography, or PET, scans are highly sensitive and are able to locate cancer cells when other diagnostic measures have failed to do so.

Mainly used to detect prostate cancer in men, Choline C 11 and PET scanning can confirm exactly where the cancer cells are and if the cancer has spread. Often, this testing is carried out on patients who have previously suffered from prostate cancer and who may be facing a recurrence of the condition.

Choline C 11 is administered intravenously and is usually delivered via a vein in the patient's arm. Known as a radioactive isotope or tracer, Choline C 11 binds to the prostate cancer cells and is absorbed by them. Once Choline C 11 had been administered, the patient is scanned and, if present, the prostate cancer cells are clearly visible due to the effects of the drug.

As Choline C 11 enables physicians to confirm whether prostate cancer is present in the body and, if so, exactly where the cells are, it ensures an accurate diagnosis is available. Furthermore, the advanced nature of the testing means that doctors can determine what type of treatment is most likely to be effective for the patient.

As Choline C 11 and PET scanning is considered to be more accurate and more sensitive than traditional diagnostic tests, it allows prostate cancer cells to be identified when other investigations or procedures have failed to do so. As a result, patients can be diagnosed earlier, when fewer cancer cells are present, and treatment can commence more quickly.

Due to the accuracy of Choline C 11, it also ensures that doctors are aware of how extensive the cancer is. Based on this, physicians can predict the patient's outcome and the likelihood of successful treatment occurring. This ensures that patients have access to an accurate diagnosis and realistic treatment plans if PET scanning confirms the presence of cancer cells.

If diagnosed early enough, prostate cancer is often receptive to treatments and even a recurrence of prostate cancer can often be treated successfully. As Choline C 11 and PET scanning enables cancer cells to be identified more quickly than other types of tests, it plays a crucial role in the diagnosis, management, and treatment of prostate cancer.

Conditions Treated

Type of Medicine

  • Radioactive isotope
  • Diagnostic Agent
  • Radiopharmaceutical

Side Effects

When patients undergo PET scanning, they will obviously be in a hospital or clinical setting. The Choline C 11 will, therefore, be administered by an experienced medical professional. Despite this, it's not uncommon for patients to experience stinging or pain at the site of the infection. Similarly, patients may notice numbness, burning or a cold feeling where the injection was administered and they may also suffer from warmth, swelling and/or redness at the injection site.

Occasionally, patients may experience some side-effects if Choline C 11 has been used in conjunction with PET scanning. If patients develop the following side-effects, they should notify their doctor:

  • Unusual weakness and/or tiredness
  • Cough
  • Trouble swallowing
  • Chest tightness
  • Shortness of breath
  • Feelings of dizziness
  • Swelling of the face, tongue, lips, throat and/or around the eyelids
  • Fast heart rate
  • Rash on the skin and/or hives and itching

Dosage

As Choline C 11 is a radiopharmaceutical, it should only be administered by experienced medical professionals. In most cases, Choline C 11 can only be delivered by physicians with specific training in nuclear medicine.

As there is no specific standard dose of Choline C 11, doctors will use their specialist skills to administer an appropriate amount of the drug, based on the patient's body shape and weight. If too little Choline C 11 is used, it may fail to provide an accurate diagnostic image, whilst too much of the drug may increase the risk of adverse effects occurring.

Doctors will determine how much Choline C 11 is given to the patient, based on their medical history and/or the results of any other diagnostic tests which may have taken place, such as a prostate-specific antigen (PSA blood test).

During the hours before the PET scan, doctors may advise the patient to drink as much water or fluid as they can manage. Normally, the four hours before the scan are particularly relevant and patients may be encouraged to drink as much water as they can tolerate during this time.

Once the scan is complete, patients will be asked to urinate immediately and encouraged to urinate as much as possible in the hour following the procedure. This ensures that Choline C 11 is eliminated from the body as quickly as possible and reduces the chance of side-effects occurring.

Warnings

Before undergoing PET scanning with Choline C 11, patients should ensure their doctors are aware of any other medications they are taking. This includes the use of over-the-counter medicines and/or vitamins and herbal supplements. In some cases, patients may need to stop taking these substances or alter the dose before being scanned. Patients should, therefore, discuss any existing treatment or medications prior to the scan, so that any modifications can be made well in advance.

When receiving Choline C 11 and being scanned, patients should be closely monitored at all times. By monitoring the patient continuously, doctors can confirm that the drug is working as it is expected to do and they can immediately discontinue Choline C 11 if they suspect that the patient is not tolerating it well.

In rare cases, patients may experience an allergic reaction to Choline C 11 and, in serious cases, this may present as anaphylaxis. This involves swelling of the fact and/or throat, increased heart rate and/or hives and itching. As the throat can swell significantly and cause difficulty in breathing, anaphylaxis is considered to be a life-threatening medical situation and treatment is required immediately.

As Choline C 11 is administered in a clinical setting, any adverse effects or allergic reactions normally occur whilst the patient is still being monitored and is under the care of the doctor. This means that adverse effects can normally be treated quickly and the physician can respond to any abnormal reactions immediately.

If the patient is concerned about the presence of side-effects once they have been discharged from the hospital, however, they should seek immediate medical advice.

As Choline C 11 is a radioactive substance, a physician should discuss the risks of carrying out the scan with patients before the procedure. Although the use of radioactive isotopes can, theoretically, have long-term adverse consequences, the benefits of using Choline C 11 to detect prostate cancer cells often outweigh the risks.

Patients should be aware that Choline C 11 has a relatively short half-life, meaning that it loses its efficacy within a fairly short amount of time. This means that the drug should be administered just before the PET scanning is carried out.

Storage

In most cases, Choline C 11 is stored in single-use vials and should be used as quickly as possible after the medicine has been calibrated. Although the optimum storage temperature for Choline C 11 is 25°C (77°F), the medication may be able to be stored at a temperature between 15° to 30°C (59° to 86°F).

As PET scanning is carried out in hospital and Choline C 11 is handled by an experienced nuclear medicine specialist, the drug will be stored securely in a clinical setting. Patients will not be expected to store this medicine at home at any time.

Summary

If patients have a history of prostate cancer, they are likely to undergo regular testing so that a potential recurrence of the disease can be identified quickly. As with all cancers, early detection and swift treatment can increase survival rates significantly.

If a recurrence of prostate cancer is suspected by traditional diagnostic tests have failed to yield results, PET scanning may be used. As one of the most sensitive scans available, PET scanning is able to highlight prostate cancer cells before many other tests, including MRI and standard CT scans.

The use of Choline C 11 is crucial to the success of PET scanning. As the Choline C 11 is absorbed by the prostate cancer cells, it makes them easy to view once the body is scanned. As well as confirming whether prostate cancer cells are present in the patient's body, physicians can also pinpoint exactly where the cells are by using Choline C 11.

If a recurrence of prostate cancer is suspected, it can be a very stressful time for patients and their family. By carrying out accurate diagnostic testing quickly, physicians can minimize waiting times and enable patients to access a diagnosis more quickly, thus reducing the patient's anxiety. As well as providing a highly accurate diagnostic test, Choline C 11 and PET scanning ensures that appropriate treatment can be offered, based on the presence of prostate cancer cells and their location.