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Does focal incidental 18F-FDG PET/CT uptake in the prostate have significance?

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Abstract

Purpose

18F-FDG PET/CT is used to characterize many malignancies, but is not recommended for localized prostate cancer. This study explores the value of multi-parametric MRI (mpMRI) in characterizing incidental prostate 18F-FDG uptake.

Methods

Thirty-one patients who underwent 18F-FDG PET/CT for reasons unrelated to prostate cancer and prostate mpMRI were eligible for this retrospective study. The mpMRI included T2-weighted (T2W), dynamic contrast enhancement (DCE), apparent diffusion coefficient (ADC), and MR spectroscopy (MRS) sequences. Fourteen patients were excluded (n = 8 insufficient histopathology, n = 6 radical prostatectomy before PET), and final analysis included 17 patients. A nuclear medicine physician, blinded to clinicopathologic findings, identified suspicious areas and maximum standardized uptake values (SUVmax) on 18F-FDG PET/CT. Sector-based imaging findings were correlated with annotated histopathology from whole-mount or MRI/transrectal ultrasound fusion biopsy samples. Positive predictive values (PPVs) were estimated using generalized estimating equations with logit link. Results were evaluated with Kruskal–Wallis and Dunn’s multiple comparisons tests.

Results

The PPV of 18F-FDG PET alone in detecting prostate cancer was 0.65. Combining 18F-FDG PET as a base parameter with mpMRI (T2W, DCE, ADC, and MRS) increased the PPV to 0.82, 0.83, 0.83, and 0.94, respectively. All benign lesions had SUVmax < 6. Malignant lesions had higher SUVmax values that correlated with Gleason scores. There was a significant difference in SUVmax per prostate between the Gleason ≥ 4 + 5 and benign categories (p = 0.03).

Conclusions

Focal incidental prostate 18F-FDG uptake has low clinical utility alone, but regions of uptake may harbor high-grade prostate cancer, especially if SUVmax > 6. Using mpMRI to further evaluate incidental 18F-FDG uptake aids the diagnosis of prostate cancer.

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Acknowledgements

This research was made possible through the National Institutes of Health (NIH) Medical Research Scholars Program, a public–private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from Pfizer Inc., The Doris Duke Charitable Foundation, The Newport Foundation, The American Association for Dental Research, The Howard Hughes Medical Institute, and the Colgate-Palmolive Company, as well as other private donors. For a complete list, please visit the Foundation website at: http://fnih.org/work/education-training-0/medical-research-scholars-program.

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Authors and Affiliations

  1. Molecular Imaging Program, National Cancer Institute, NIH, 10 Center Drive, Room B3B85, Bethesda, MD, 20892, USA

    Anna M. Brown, Maria L. Lindenberg, Sandeep Sankineni, Linda M. Johnson, Suneha Pruthy, Karen A. Kurdziel, Peter L. Choyke & Baris Turkbey

  2. Duke University School of Medicine, Durham, NC, USA

    Anna M. Brown

  3. Biometric Research Branch, Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, MD, USA

    Joanna H. Shih

  4. Laboratory of Pathology, NCI, NIH, Bethesda, MD, USA

    Maria J. Merino

  5. Center for Interventional Oncology, NCI, NIH, Bethesda, MD, USA

    Bradford J. Wood

  6. Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD, USA

    Bradford J. Wood

  7. Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA

    Peter A. Pinto

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  1. Anna M. Brown
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  2. Maria L. Lindenberg
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  8. Maria J. Merino
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  9. Bradford J. Wood
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  11. Peter L. Choyke
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  12. Baris Turkbey
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Corresponding author

Correspondence to Baris Turkbey.

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Brown, A.M., Lindenberg, M.L., Sankineni, S. et al. Does focal incidental 18F-FDG PET/CT uptake in the prostate have significance?. Abdom Imaging 40, 3222–3229 (2015). https://doi.org/10.1007/s00261-015-0520-y

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  • DOI: https://doi.org/10.1007/s00261-015-0520-y

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