Is There Use for FDG-PET in Prostate Cancer?

https://doi.org/10.1053/j.semnuclmed.2016.07.004Get rights and content

The use of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in prostate cancer depends on the phase of the disease along the natural history of this prevalent malignancy in men. Incidental high FDG uptake in the prostate gland, although rare, should prompt further investigation with at least a measurement of serum prostate specific antigen level. Although in general FDG uptake level may significantly overlap among normal, benign, and malignant tissues, aggressive primary tumors with Gleason score > 7 tend to display high FDG uptake. PET with FDG may be useful in staging of those patients with aggressive primary tumors and can localize the site of disease in a small fraction of men with biochemical failure and negative conventional imaging studies. FDG-PET may be quite useful in treatment response assessment and prognostication of patients with castrate-resistant metastatic 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)

  • E. Salminen et al.

    Investigations with FDG PET scanning in prostate cancer show limited value for clinical practice

    Acta Oncol

    (2002)
  • H. Jadvar et al.

    [F-18]-fluorodeoxyglucose PET-CT of the normal prostate gland

    Ann Nucl Med

    (2008)
  • H. Jadvar

    Molecular imaging of prostate cancer with [F-18]-fluorodeoxyglucose PET

    Nat Rev Urol

    (2009)
  • H. Jadvar

    Imaging evaluation of prostate cancer with 18F-flurodeoxyglucose PET/CT: Utility and limitations

    Eur J Nucl Med Mol Imaging

    (2013)
  • E. Sahin et al.

    Clinical significance of incidental FDG uptake in the prostate gland detected by PET/CT

    Int J Clin Exp Med

    (2015)
  • A.M. Brown et al.

    Does focal incidental 18F-FDG uptake in the prostate gland have significance?

    Abdom Imaging

    (2015)
  • F. Bertagna et al.

    Incidental uptake of 18F-fluorodeoxyglucose in the prostate gland. Systematic review and meta-analysis on prevalence and risk of malignancy

    Nuklearmedizin

    (2014)
  • P.M. Kang et al.

    Incidental abnormal FDG uptake in the prostate on 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography

    Asian Pac J Cancer Prev

    (2014)
  • H. Seino et al.

    Incidental prostate 18F-FDG uptake without calcification indicates possibility of prostate cancer

    Oncol Rep

    (2014)
  • R. Minamimoto et al.

    The potential of FDG PET/CT for detecting prostate cancer in patients with an elevated serum PSA level

    Ann Nucl Med

    (2011)
  • 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.

    View full text