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We report here about a 59-year-old man with bone metastatic castration-resistant prostate cancer and biochemical progression, who underwent radium-223 (Ra-223) therapy, following previous treatment failure. Treatment response of osseous metastases was assessed with three  11 C-choline positron emission tomography/computed tomography (PET/CT) scans at baseline, after three cycles for early monitoring, as well as after six cycles of radium-223 therapy. Pretreatment  11 C-choline PET/CT showed multiple areas of increased focal activity in multiple cervical, thoracic, and lumbar vertebrae as well as in both ribs, right ileum, and left ischium. Second  11 C-choline PET/CT after three cycles showed increasing tumor activity in the existing lesions and the new uptake spots of thoracic spine, both ribs and left ileum. Third  11 C-choline PET/CT at the end of the therapy showed further progression with new lesions of thoratic spine, sacrum, right rib, and right ileum. In this case,  11 C-choline PET/CT after three cycles for early monitoring could predict the therapeutic response to Ra-223.

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The Potential Use of 11C-Choline Positron Emission Tomography/Computed Tomography to Monitor the Treatment Effects of Radium-223 in a Patient with Prostate Cancer