Skip to main content
SpringerLink
Log in

Is further evaluation needed for incidental focal uptake in the prostate in 18-fluoro-2-deoxyglucose positron emission tomography–computed tomography images?

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to investigate the frequency of secondary evaluation to detect prostate cancer that was primarily manifested as abnormal hypermetabolism detected by 18-fluoro-2-deoxyglucose (FDG) positron emission tomography–computed tomography (PET/CT). We also evaluated the association of maximum standardized uptake values (SUVmax) on PET/CT with clinicopathologic results.

Materials and methods

We evaluated PET/CT reports from a total of 12,037 patients to find cases with abnormal prostate hypermetabolism. Patients with known prostate cancer or a recent prostate procedure were excluded. We analyzed the frequency of secondary evaluations such as digital rectal exams (DRE), levels of serum prostate-specific antigen (PSA), and/or biopsy to confirm prostate cancer. Biopsied patients were categorized into benign and cancer groups. Clinicopathologic characteristics were compared between the groups.

Results

Among 12,037 PET/CT images, 184 (1.5 %) showed abnormal hypermetabolism in the prostate. Secondary evaluation was carried out in 120 patients. Biopsy was performed in 38 patients and prostate cancer was confirmed in 23 patients. The median serum PSA level was 3.2 and 49.7 ng/mL in the benign group and cancer group, respectively. The SUVmax was higher in the cancer group (5.7 ± 5.1) than in the benign group (4.8 ± 2.7), but the difference was not statistically significant (p = 0.37). In the cancer group, a high serum PSA level (≥20 ng/mL) was detected in 78.3 % of the patients. The Gleason score was 7 in 34.7 % and 8–10 in 56.5 % of prostate cancer patients.

Conclusions

Hypermetabolism in the prostate was incidentally detected in 1.5 % of patients, and only 65.2 % of these patients underwent further evaluation (DRE and/or serum PSA levels). Among cases of incidentally detected hypermetabolism in the prostate, patients with abnormal findings (DRE and/or PSA levels) showed high positivity by biopsy, and more than two-thirds of the positive biopsies showed significant prostate cancer. Therefore, patients with hypermetabolism in the prostate should not be ignored and should be secondarily evaluated by DRE and PSA level.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Han EJ. H OJ, Choi WH, Yoo IR, Chung SK. Significance of incidental focal uptake in prostate on 18-fluoro-2-deoxyglucose positron emission tomography CT images. Br J Radiol. 2010;83:915–20.

    Article  PubMed  CAS  Google Scholar 

  2. von Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: current applications and future directions. Radiology. 2006;238:405–22.

    Article  Google Scholar 

  3. Lee JW, Kang KW, Paeng JC, Lee SM, Jang SJ, Chung JK, et al. Cancer screening using 18F-FDG PET/CT in Korean asymptomatic volunteers: a preliminary report. Ann Nucl Med. 2009;23:685–91.

    Article  PubMed  Google Scholar 

  4. Minamimoto R, Senda M, Uno K, Jinnouchi S, Iinuma T, Ito K, et al. Performance profile of FDG-PET and PET/CT for cancer screening on the basis of a Japanese Nationwide Survey. Ann Nucl Med. 2007;21:481–98.

    Article  PubMed  Google Scholar 

  5. Bouchelouche K, Oehr P. Positron emission tomography and positron emission tomography/computerized tomography of urological malignancies: an update review. J Urol. 2008;179:34–45.

    Article  PubMed  CAS  Google Scholar 

  6. von Mallek D, Backhaus B, Muller SC, Matthies A, Palmedo H, Jaeger U, et al. Technical limits of PET/CT with 18FDG in prostate cancer. Aktuelle Urol. 2006;37:218–21.

    Article  Google Scholar 

  7. Wang X, Koch S. Positron emission tomography/computed tomography potential pitfalls and artifacts. Curr Probl Diagn Radiol. 2009;38:156–69.

    Article  PubMed  Google Scholar 

  8. Kojima S, Zhou B, Teramukai S, Hara A, Kosaka N, Matsuo Y, et al. Cancer screening of healthy volunteers using whole-body 18F-FDG-PET scans: the Nishidai clinic study. Eur J Cancer. 2007;43:1842–8.

    Article  PubMed  Google Scholar 

  9. Hoh CK, Seltzer MA, Franklin J, de Kernion JB, Phelps ME, Belldegrun A. Positron emission tomography in urological oncology. J Urol. 1998;159:347–56.

    Article  PubMed  CAS  Google Scholar 

  10. Lawrentschuk N, Davis ID, Bolton DM, Scott AM. Positron emission tomography and molecular imaging of the prostate: an update. BJU Int. 2006;97:923–31.

    Article  PubMed  CAS  Google Scholar 

  11. Kao PF, Chou YH, Lai CW. Diffuse FDG uptake in acute prostatitis. Clin Nucl Med. 2008;33:308–10.

    Article  PubMed  Google Scholar 

  12. Oyama N, Akino H, Kanamaru H, Okada K. Fluorodeoxyglucose positron emission tomography in diagnosis of untreated prostate cancer. Nihon Rinsho. 1998;56:2052–5.

    PubMed  CAS  Google Scholar 

  13. Nathan M, Rohren E. FDG uptake in the prostate gland on PET/CT: a worrisome sign for prostate cancer regardless of PSA level. J Nucl Med. 2006;47(1 Suppl):180P.

    Google Scholar 

  14. Mohler J, Bahnson RR, Boston B, Busby JE, D’Amico A, Eastham JA, et al. NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw. 2010;8:162–200.

    PubMed  CAS  Google Scholar 

  15. Minamimoto R, Uemura H, Sano F, Terao H, Nagashima Y, Yamanaka S, et al. The potential of FDG-PET/CT for detecting prostate cancer in patients with an elevated serum PSA level. Ann Nucl Med. 2011;25:21–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Urology, Chonnam National University Medical School, 671, Jebongno, Donggu, Gwangju, 501-757, Republic of Korea

    Insang Hwang, Seung-Il Jung, Eu-Chang Hwang, Sun-Ouck Kim, Taek-Won Kang, Dong-Deuk Kwon, Kwangsung Park & Soo-Bang Ryu

  2. Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea

    Ari Chong

Authors
  1. Insang Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ari Chong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seung-Il Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eu-Chang Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sun-Ouck Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Taek-Won Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dong-Deuk Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kwangsung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Soo-Bang Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seung-Il Jung.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hwang, I., Chong, A., Jung, SI. et al. Is further evaluation needed for incidental focal uptake in the prostate in 18-fluoro-2-deoxyglucose positron emission tomography–computed tomography images?. Ann Nucl Med 27, 140–145 (2013). https://doi.org/10.1007/s12149-012-0663-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-012-0663-7

Keywords

Search

Navigation