Fluorodeoxyglucose positron emission tomography studies in diagnosis and staging of clinically organ-confined prostate cancer

Incidental diagnosis of a PSA-negative prostate cancer by 18FDG PET/CT in a patient with hypopharyngeal cancer

“…The increased FDG uptake within the prostate in this specific case was surprising and has to be discussed owing to the well-known limitations and pitfalls of FDG-PET with a reported sensitivity as low as 4% in the diagnosis of primary PC. 2 According to the present case, Melchior et al 20 found higher FDG accumulation in poorly differentiated PCs than in low grade prostate malignancies. In a further study, Oyama et al 21 examined 44 consecutive patients with histologically proven adenocarcinoma of the prostate.…”

“…This has to be emphasized as these biochemical findings are sometimes unspecific and may also be found in patients with nonmalignant diseases of the prostate gland such as benign hyperplasia, prostatitis or even in healthy individuals. [2][3][4][5][6]9,[12][13][14][15][16][17][18] Even the described slight increase of the PSA level from 1.68 to 2.21 ng/ml after 2 years, which consecutively decreased to 1.9 ng/ml at the time of surgery, or a potential rise of the percent-free PSA in relation to total PSA, would not have required a prostate biopsy in any case as, despite the described rise of the PSA, PSA levels were still within and even not at the upper limit (4.0 ng/ml) of the normal range. In addition, estimation of percent-free PSA is also prone to variations between malignant and benign masses of the prostate.…”

“…This is mainly owing to the fact that alterations in serum PSA levels do not always correspond to the underlying disease of the prostate and/or its clinical outcome. 2 Furthermore, recent research has shown that clinically significant PC can also develop in patients with a PSA value o4ng/ml, frequently defined as upper limit of normal serum PSA levels. Consequently, 'watchful waiting' approaches have been suggested not to be appropriate for young patients or those with a life expectancy of greater than 15 years.…”

“…11 Consequently, several previously published studies failed to show a beneficial impact of FDG-PET, except in the detection and localization of distant metastases in hormone-refractory PC. 2,5,6,9,[12][13][14][15] Additionally, even the recently introduced PET/CT technique, adding morphological information to metabolic data of FDG-PET, failed to improve the diagnostic value of FDG-PET imaging for PC in a small series of patients. 15 Data regarding new radiotracers for the diagnosis of PC, for example 11 C-choline, seem to have a beneficial impact on the diagnostic value as compared to FDG-PET, but data are still discussed controversially and, as of yet, failed to show a significant correlation between the uptake of 11 C-choline and tumor grade or Gleason score.…”

18F-fluorocholine for prostate cancer imaging: a systematic review of the literature

“…8 However, this modality is less accurate for the diagnosis and staging of PCa. [9][10][11][12] Given the limitations of conventional imaging modalities, a PET/CT imaging agent tailored to prostate cancer detection would be a clear advance in prostate cancer localization and staging. Radiolabeled amino acid tracers such as anti-1-amino-3-18 F-fluorocyclobutyl-1-carboxylic acid ( 18 F-FACBC), 11 C-methionine and 99m Tc-bombesin, or radiolabeled androgen tracers such as 18 F-16b-fluoro5a-dihydrotestosterone ( 18 F-FDHT), or radiolabeled choline and choline analog probes such as 11 C-acetate, 11 C-choline and [ 18 F]fluoromethyl-dimethyl-2-hydroxyethyl-ammonium ( 18 F-FCH) have been recently developed for prostate cancer imaging.…”