Is There Use for FDG-PET in Prostate Cancer?☆
Section snippets
Detection of Primary Prostate Tumor
To localize a potential primary tumor, one needs to know what the range of physiological or benign FDG uptake level may be in the prostate gland. The normal prostate gland generally demonstrates relatively low and homogeneous FDG uptake. One study attempted to quantify the uptake level in the presumed normal prostate gland of 145 men with no documented signs or symptoms of prostate gland disease, normal serum prostate specific antigen (PSA) level, and no visible prostatic calcifications on CT
Initial Staging of Prostate Cancer
There are a paucity of data on the use of FDG PET-CT in the initial staging of primary prostate cancer as this modality is not generally advocated in the imaging evaluation of men suspected of harboring prostate cancer. Liu18 reported on a retrospective study of nine patients (mean serum PSA level of 291 ± 363 ng/mL with range of 6.1-980 ng/mL) who underwent FDG PET-CT at the time of initial staging of known primary prostate cancer. Standard of reference for the PET observations was by biopsy,
Localization of Disease in Biochemical Recurrence
Biochemical recurrence (aka. PSA relapse and biochemical failure) is defined differently depending upon the initial treatment for primary prostate cancer. In prostatectomized patients, biochemical recurrence is declared when there is an initial serum PSA of 0.2 ng/mL or higher with a second confirmatory PSA rise.24 In patients who had undergone external beam radiation therapy, this clinical condition is asserted when there is a serum PSA rise by 2 ng/mL or more above the nadir PSA level.25
Therapy Response Assessment
A major use of FDG PET in oncology has been to assess objectively the response to a variety of treatments at various periods in the clinical management of the disease such as at neoadjuvant, adjuvant, primary, or salvage settings. Overall, there are little data available for FDG PET-CT in the imaging evaluation of response to treatment in patients with metastatic prostate cancer. FDG uptake in metastatic lesions tends to decrease with androgen deprivation therapy or chemotherapy, but there may
Prognosis Assessment
The ability to assess outcome in patients with cancer using noninvasive imaging is powerful and of major use in clinical decision-making and individual patient management. Relevant outcome measures in prostate cancer may include, but are not limited to, time to biochemical recurrence (time to PSA progression), time to first metastasis, time to symptomatic progression, time to initiation of cytotoxic chemotherapy, time to radiographic progression, time to castrate resistance state,
Conclusions
FDG PET-CT may be useful in diagnosis and staging of aggressive primary prostate tumors (Gleason score > 7) and as such incidental findings of high FDG uptake in the prostate gland should be further investigated. FDG PET-CT may also be useful in the detection of metastatic disease in a small fraction of men with biochemical failure with scan sensitivity that increases with increasing serum PSA level, in the assessment of extent of metabolically active castrate resistant metastatic disease, in
References (40)
- et al.
PET: A revolution in medical imaging
Radiol Clin North Am
(2004) - et al.
Fluorodeoxyglucose positron emission tomography studies in diagnosis and staging of clinically organ-confined prostate cancer
Urology
(2001) - et al.
Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: The American Urological Association prostate guidelines for localized prostate cancer update panel report and recommendations for a standard in the reporting of surgical outcomes
J Urol
(2007) - et al.
Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendations of the RTOG-ASTRO Phoenix consensus conference
Int J Radiat Oncol Biol Phys
(2006) - et al.
Comparison of helical computerized tomography, positron emission tomography and monoclonal antibody scans for evaluation of lymph node metastases in patients with prostate specific antigen relapse after treatment for localized prostate cancer
J Urol
(1999) Prognostic utility of PET in prostate cancer
PET Clin
(2015)- et al.
Prognostic value of 2-deoxy-2-[F-18]fluoro-d-glucose positron emission tomography imaging for patients with prostate cancer
Mol Imaging Biol
(2002) - et al.
Current status of PET-MRI in oncologic imaging
AJR Am J Roentgenol
(2016) - et al.
Simultaneous whole-body PET/MR imaging in comparison to PET/CT in pediatric oncology: Initial results
Radiology
(2014) - et al.
Fluorine-18-fluorodeoxyglucose positron emission tomography is useless for detection of local recurrence after radical prostatectomy
Eur Urol
(1999)
Investigations with FDG PET scanning in prostate cancer show limited value for clinical practice
Acta Oncol
[F-18]-fluorodeoxyglucose PET-CT of the normal prostate gland
Ann Nucl Med
Molecular imaging of prostate cancer with [F-18]-fluorodeoxyglucose PET
Nat Rev Urol
Imaging evaluation of prostate cancer with 18F-flurodeoxyglucose PET/CT: Utility and limitations
Eur J Nucl Med Mol Imaging
Clinical significance of incidental FDG uptake in the prostate gland detected by PET/CT
Int J Clin Exp Med
Does focal incidental 18F-FDG uptake in the prostate gland have significance?
Abdom Imaging
Incidental uptake of 18F-fluorodeoxyglucose in the prostate gland. Systematic review and meta-analysis on prevalence and risk of malignancy
Nuklearmedizin
Incidental abnormal FDG uptake in the prostate on 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography
Asian Pac J Cancer Prev
Incidental prostate 18F-FDG uptake without calcification indicates possibility of prostate cancer
Oncol Rep
The potential of FDG PET/CT for detecting prostate cancer in patients with an elevated serum PSA level
Ann Nucl Med
Cited by (0)
- ☆
H. Jadvar was supported in part by the National Institutes of Health Grants R01-CA111613, R21-CA142426, R21-EB017568, and P30-CA014089.