Priya Ranjit Bhosale MD, Presenter: Nothing to Disclose

Ramanujam Govindarajan Prativadi, Abstract Co-Author: Nothing to Disclose

Aparna Balachandran MD, Abstract Co-Author: Nothing to Disclose

Raghunandan Vikram MBBS, Abstract Co-Author: Nothing to Disclose

Wei Wei, Abstract Co-Author: Nothing to Disclose

Catherine Ellen Devine MD, Abstract Co-Author: Nothing to Disclose

Vikas Kundra MD, PhD, Abstract Co-Author: Nothing to Disclose

Eric Michael Rohren MD, PhD, Abstract Co-Author: Nothing to Disclose

To determine clinical significance of unexpected, abnormal FDG uptake in prostate gland in patients undergoing PET/CT for staging of other primary malignancies and without a prior history of prostate carcinoma.

  A retrospective search was performed of FDG-PET/CT studies performed at our institution between 4/1/06 and 6/30/09, in order to identify patients with unexpected abnormal FDG uptake in the prostate gland and who underwent subsequent biopsy. Patients with known prostate carcinoma were excluded from analysis. 26 patients were identified in this process. The images from these patients were reviewed in order to determine the pattern of uptake within the prostate (focal or diffuse), and the intensity of prostate activity (represented by the maximum standardized uptake value). Patient age and PSA values were also recorded.  

Of the 26 patients with abnormal FDG uptake in the prostate who underwent prostate biopsy, 15 (64%) were found to have occult prostate cancer. The Gleason score in this group ranged from 6-9. The remaining 9 patients did not have prostate cancer on biopsy. There was no statistical difference in the pattern of prostate activity (focal vs. diffuse) or the maximum SUV between the group with prostate cancer and the group without. However, there was a correlation with serum PSA, with higher values in the group with cancer (range 2 - 26.8, mean 10.2) compared to those without cancer (range 2 – 10.5, mean 2.2), a result which was statistically significant (P value of <0.0007 based on Wilcoxon rank sum test).

At our institution, patients with unexpected abnormal FDG uptake in the prostate gland on PET/CT who underwent subsequent transrectal biopsy had a high likelihood (64%) of occult prostate cancer. Abnormal prostate uptake on FDG-PET/CT should therefore be viewed with suspicion, particularly in the setting of an elevated serum PSA. Future studies are needed to develop a strategy for follow up and investigation of such patients.

FDG uptake in the prostate can be due to prostate cancer and biopsy should be performed to differentate this from beningn prostatic hypertrophy or prostatitis.

Bhosale, P, Prativadi, R, Balachandran, A, Vikram, R, Wei, W, Devine, C, Kundra, V, Rohren, E, What Is the Clinical Significance of FDG Uptake in the Prostate in a Patient Undergoing a PET/CT?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9005456.html