Fluorine-18 fluoroacetate [1] appears to be an interesting alternative to 11C-acetate [2, 3] for imaging prostate cancer with PET. We acquired the first 18F-fluoroacetate PET images in a patient with prostate cancer, rising PSA (101 ng/ml) and progressive bone metastases. Scanning started 70 min after i.v. injection of 280 MBq 18F-fluoroacetate using a combined PET/CT system (Siemens Biograph).

The images demonstrate moderate to intense uptake in several (thick arrows) but not all (thin arrows) metastatic bone lesions, with SUVmean of 2.82–4.10 and SUVmax of 3.36–5.11. This compared favourably to accumulation in the liver, with SUVmean of 2.35–2.71 and SUVmax of 3.0–3.58. The mode of excretion was predominantly via the bowel (arrowheads), with low activity in the urine.

Compared with 11C-acetate PET, 18F-fluoroacetate offers the possibility of delayed imaging with the potential to further increase the tumour-to-background ratios.

Upper row: CT image slices; middle row: combined 18F-fluoroacetate PET/CT; lower row : 18F-fluoroacetate PET