Role of Tc-99m Ciprofloxacin Imaging in the Diagnosis of Bacterial Prostatitis

Lee, Sung Min; Ryu, Ji Kan; Suh, Jun Kyu

Abstract

PURPOSE: With traditional laboratory tests it is often difficult to differentiate chronic bacterial prostatitis (CBP) from chronic pelvic pain syndrome (CPPS), resulting in inappropriate antibiotic therapy, without definite evidence of infection. Tc-99m Ciprofloxacin imaging was developed to discriminate an infection from inflammation. The value of this imaging for differential diagnosis of CBP was investigated.
MATERIALS AND METHODS
The study included 104 patients diagnosed as CBP or CPPS by traditional laboratory tests and 4 normal subjects and 2 patients with acute prostatitis or cystourethritis as positive and negative controls, respectively. Patients that had received antibiotic therapy within the previous 6 weeks were excluded. Single photon emission computerized tomography (SPECT) images were obtained 3 hours after an injection of Tc-99m Ciprofloxacin. The results of the imaging were compared with those of the 4-glass test for identification of microorganism.
RESULTS
On the images, negative uptake was shown in all normal subjects, while strong hot uptake was shown in the entire prostate of the patient with acute prostatitis and the entire urethra of the patient with acute cystourethritis. Based on traditional laboratory tests, 104 patients were classified as CBP (n=32) and CPPS (n=72). Nine of the 32 CBP patients (28%) showed negative uptake in the prostate, and 47 (65%) of the 72 CPPS patients showed hot uptake in the prostate.
CONCLUSIONS
Tc-99m Ciprofloxacin imaging may have potential as a diagnostic technique for the discrimination of chronic bacterial prostatitis that cannot be identified by traditional laboratory tests.