Volumetric assessment of PET signals becomes increasingly relevant for radiotherapy (RT) planning. Here, we investigate the utility of ¹⁸F-choline PET signals to serve as a structure for semi-automatic segmentation for forward treatment planning of prostate cancer. ¹⁸F-choline PET and CT scans of ten patients with histologically proven prostate cancer without extracapsular growth were acquired using a combined PET/CT scanner. Target volumes were manually delineated on CT images using standard software. Volumes were also obtained from ¹⁸F-choline PET images using an asymmetrical segmentation algorithm. PTVs were derived from CT ¹⁸F-choline PET based clinical target volumes (CTVs) by automatic expansion and comparative planning was performed. As a read-out for dose given to non-target structures, dose to the rectal wall was assessed. Planning target volumes (PTVs) derived from CT and ¹⁸F-choline PET yielded comparable results. Optimal matching of CT and ¹⁸F-choline PET derived volumes in the lateral and cranial-caudal directions was obtained using a background-subtracted signal thresholds of 23.0+/-2.6%. In antero-posterior direction, where adaptation compensating for rectal signal overflow was required, optimal matching was achieved with a threshold of 49.5+/-4.6%. 3D-conformal planning with CT or ¹⁸F-choline PET resulted in comparable doses to the rectal wall. Choline PET signals of the prostate provide adequate spatial information amendable to standardized asymmetrical region growing algorithms for PET-based target volume definition for external beam RT.

Keywords: PET; Functional imaging; Image-guided therapy; Prostate cancer; PET/CT; ¹⁸Fluoro-Choline; Radiotherapy planning; and Radiation oncology.