Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Sep 28, 2017; 9(9): 350-358
Published online Sep 28, 2017. doi: 10.4329/wjr.v9.i9.350
Clinical significance of prostate 18F-labelled fluorodeoxyglucose uptake on positron emission tomography/computed tomography: A five-year review
Madhurima R Chetan, Tristan Barrett, Ferdia A Gallagher
Madhurima R Chetan, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, United Kingdom
Tristan Barrett, Ferdia A Gallagher, Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, United Kingdom
Author contributions: Chetan MR, Barrett T and Gallagher FA designed the research; Chetan MR performed the research; Chetan MR, Barrett T and Gallagher FA analysed the data; Chetan MR wrote the paper; Barrett T and Gallagher FA critically revised the manuscript for important intellectual content.
Institutional review board statement: The study was reviewed and approved by Addenbrooke’s Hospital, Cambridge.
Informed consent statement: The requirement for informed consent for data analysis was waived.
Conflict-of-interest statement: The authors have no competing interests.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tristan Barrett, MB BS, BSc, MRCP, FRCR, Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Box 218, Cambridge CB2 0QQ, United Kingdom. tb507@medschl.cam.ac.uk
Telephone: +44-1223-336890 Fax: +44-1223-330915
Received: September 20, 2016
Peer-review started: September 23, 2016
First decision: November 21, 2016
Revised: February 20, 2017
Accepted: March 21, 2017
Article in press: March 22, 2017
Published online: September 28, 2017
Abstract
AIM

To determine the significance and need for investigation of incidental prostatic uptake in men undergoing 18F-labelled fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for other indications.

METHODS

Hospital databases were searched over a 5-year period for patients undergoing both PET/CT and prostate magnetic resonance imaging (MRI). For the initial analysis, the prostate was divided into six sectors and suspicious or malignant sectors were identified using MRI and histopathology reports respectively. Maximum and mean 18F-FDG standardised uptake values were measured in each sector by an investigator blinded to the MRI and histopathology findings. Two age-matched controls were selected per case. Results were analysed using a paired t-test and one-way ANOVA. For the second analysis, PET/CT reports were searched for prostatic uptake reported incidentally and these patients were followed up.

RESULTS

Over a 5-year period, 15 patients underwent both PET/CT and MRI and had biopsy-proven prostate cancer. Malignant prostatic sectors had a trend to higher 18F-FDG uptake than benign sectors, however this was neither clinically nor statistically significant (3.13 ± 0.58 vs 2.86 ± 0.68, P > 0.05). 18F-FDG uptake showed no correlation with the presence or histopathological grade of tumour. 18F-FDG uptake in cases with prostate cancer was comparable to that from age-matched controls. Forty-six (1.6%) of 2846 PET/CTs over a 5-year period reported incidental prostatic uptake. Of these, 18 (0.6%) were investigated by PSA, 9 (0.3%) were referred to urology, with 3 (0.1%) undergoing MRI and/or biopsy. No cases of prostate cancer were diagnosed in patients with incidental 18F-FDG uptake in our institute over a 5-year period.

CONCLUSION

18F-FDG uptake overlaps significantly between malignant and benign prostatic conditions. Subsequent patient management was not affected by the reporting of incidental focal prostatic uptake in this cohort.

Keywords: 18F-labelled fluorodeoxyglucose, Positron emission tomography reporting, Positron emission tomography/computed tomography, Prostate cancer, Magnetic resonance imaging

Core tip:18F-labelled fluorodeoxyglucose (18F-FDG) uptake overlaps significantly between malignant and benign prostatic conditions. In a cohort of nearly 3000 patients over a 5-year period, the reporting of incidental elevated prostatic 18F-FDG uptake did not affect subsequent clinical management or patient outcomes.