Incidental fleurodeoxyglucose uptake in the prostate

Abstract

ABSTRACT. This commentary confirms the rarity of prostatic cancer associated with incidental prostatic fleurodeoxyglucose (FDG) uptake. The study adds to the literature by showing that even if a prostate lesion is FDG avid it is unlikely to be due to cancer. The commentary considers the management of incidental prostate FDG uptake on the basis of the available evidence. The study on the incidence of prostate cancer in patients with incidental fleurodeoxyglucose (FDG) foci in the prostate has provoked this commentary [1]. It is clearly established that, in general, prostate adenocarcinomas show no or mild FDG uptake [2][3][4][5]. However, poorly differentiated cancers or those with a rapid cell turnover owing to the acceleration of disease will have a greater uptake of FDG and show FDG-avid areas within the prostate [4]. Benign lesions can also show FDG uptake [5][6][7]. This creates a dilemma. How do we manage incidental foci of FDG uptake in the prostate gland?Incidental FDG-avid prostate cancer is a very rare finding in patients who undergo FDG positron emission tomography (PET)/PET CT. 1 incidental FDG-avid prostate adenocarcinoma was found in a retrospective review of 1721 FDG PET CTs undertaken for the evaluation of known or suspected cancer [8]. A survey of 1197 FDG PET CTs in healthy volunteers who were part of a health screening programme, 4 prostate cancers were identified and only 1 was FDG avid [9]. 2 FDG-avid prostate cancers were found among 9347 asymptomatic members of a health screening plan comprising 24 772 health screening sessions [10]. 5 prostate cancers were identified in a cancer screening study comprising 4481 individuals, and 2 were FDG avid [11]. A similar study of 1283 patients found no FDG-avid prostatic cancers [12].It is unclear from these studies what the likelihood is of an FDG-avid lesion being benign. This information will increase our knowledge and understanding of how to deal with the challenge of the further management of incidental foci of FDG uptake in the prostate gland.Eun Ji Han's [1] study confirms the rarity of prostate cancer associated with incidental prostatic FDG uptake. The retrospective observational study included 5119 FDG PET CTs obtained as part of clinical workup for cancer, excluding those done for staging or restaging prostate cancer, and as a part of a health screening programme. Of the 5119 patients in this study, only 3 were confirmed as having FDG-avid prostate cancers [1].Eun Ji Han's study adds to the literature by showing that even if a prostate lesion is FDG avid, it is unlikely to be due to cancer. 53 of 55 patients with focal FDG uptake were considered to have benign lesions. The estimate may be imprecise. The number of patients with focal FDG uptake in the prostate was small, eight cases were lost to follow-up and biopsy confirmation of benign pathology was made in only four cases. Benign FDG uptake was assumed if no disease was present, which included, in some cases, imaging at least a year later.Eun Ji Han and his colleagues found that the maxim...

Incidental uptake of 18F-fluorodeoxyglucose in the prostate gland

“…Reviewing titles and abstracts, 56 articles were excluded because reported data were not within the field of interest of this review. Reviewing the full-text of the remaining 14 articles (6-8, 12-14, 18, 19, 21-23, 28-30), 3 articles were excluded as comments or conference proceedings (19,23,29); 4 articles were excluded as case reports (7,14,18,28). Finally, 7 articles were selected (6,8,12,13,21,22,30) for the systematic review.…”