Korean J Urol.  2015 Apr;56(4):288-294. 10.4111/kju.2015.56.4.288.

Prevalence and clinical significance of incidental 18F-fluoro-2-deoxyglucose uptake in prostate

• Kwon T
• Jeong IG
• You D
• Hong JH
• Ahn H
• Kim CS

• KMID: 2155304
• DOI: http://doi.org/10.4111/kju.2015.56.4.288

Abstract

PURPOSE
To investigate the prevalence and clinical significance of incidental prostate fluoro-2-deoxyglucose (FDG) uptake and to evaluate its impact on patient management.
MATERIALS AND METHODS
Of 47,109 men who underwent FDG positron emission tomography between 2004 and 2014, 1,335 (2.83%) demonstrated incidental FDG uptake in the prostate, with 99 of the latter undergoing prostate biopsy. The primary end point was the histological presence of prostate adenocarcinoma in the biopsy specimen. Outcomes, including treatment methods, survival, and causes of death, were also assessed. Factors associated with the diagnosis of prostate cancer were evaluated by using logistic regression analysis.
RESULTS
Patients with prostate cancer were more likely to have higher serum prostate-specific antigen (PSA) (p=0.001) and focal FDG uptake (p=0.036) than were those without. Prostate cancer occurred in 1 of 26 patients (3.8%) with serum PSA<2.5 ng/mL, compared with 40 of 67 patients (59.7%) with serum PSA> or =2.5 ng/mL. Multivariable analysis showed that focal lesions (odds ratio [OR], 5.50; p=0.038), age (OR, 1.06; p=0.031), and serum PSA (OR, 1.28; p=0.001) were independent predictors of prostate cancer diagnosis. Most patients with prostate cancer had organ-confined tumors. Of these, 12 (29.3%) underwent radical prostatectomy and 25 (60.9%) received hormone therapy. Of the 11 patients who died, 9 died of primary cancer progression, with only 1 patient dying from prostate cancer.
CONCLUSIONS
The prevalence of incidental FDG uptake in the prostate was not high, although patients with elevated serum PSA had a higher incidence of prostate cancer. Patients with FDG uptake in the prostate should be secondarily evaluated by measuring serum PSA, with those having high serum PSA undergoing prostate biopsy.

Keyword

Incidental findings; Positron-emission tomography; Prostate neoplasms

MeSH Terms

*Adenocarcinoma/epidemiology/pathology/surgery
Aged
Biopsy
Fluorodeoxyglucose F18/*pharmacokinetics
Humans
Incidental Findings
Male
Middle Aged
Organ Specificity
Positron-Emission Tomography/*adverse effects
Prevalence
*Prostate/drug effects/pathology
Prostatectomy/methods/statistics & numerical data
*Prostatic Neoplasms/epidemiology/pathology/surgery
Radiopharmaceuticals/pharmacokinetics
Republic of Korea/epidemiology
Retrospective Studies
Tissue Distribution
Fluorodeoxyglucose F18
Radiopharmaceuticals

Figure

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  Fig. 1 Flow diagram of patient selection. 18F-FDG PET, 18F-fluoro-2-deoxyglucose positron emission tomography; w/u, workup.

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  Fig. 2 Axial views of FDG uptake by the prostate. (A) Diffusion-weighted image showing focal uptake. (B) PET image showing focal uptake (maximum SUV, 13.3). (C) Diffusion showing diffuse uptake. (D) PET image showing diffuse uptake (maximum SUV, 3.1). FDG, fluoro-2-deoxyglucose; PET, positron emission tomography; SUV, standardized uptake value.

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