Incidental prostate 18F-FDG uptake without calcification indicates the possibility of prostate cancer

Seino,Hiroko; Ono,Shuichi; Miura,Hiroyuki; Morohashi,Satoko; Wu,Yunyan; Tsushima,Fumiyasu; Takai,Yoshihiro; Kijima,Hiroshi

doi:10.3892/or.2014.3011

Incidental prostate 18F-FDG uptake without calcification indicates the possibility of prostate cancer

Authors:
- Hiroko Seino
- Shuichi Ono
- Hiroyuki Miura
- Satoko Morohashi
- Yunyan Wu
- Fumiyasu Tsushima
- Yoshihiro Takai
- Hiroshi Kijima
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Affiliations: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan, Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
Published online on: February 4, 2014 https://doi.org/10.3892/or.2014.3011
Pages: 1517-1522
Copyright: © Seino et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

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Abstract

Incidental 18F-fluorodeoxyglucose (18F-FDG) uptake in the prostate is often experienced in clinical practice; however, it is difficult to determine whether incidental uptake is indicative of a malignancy or benign state based on the maximum standardized uptake value (SUVmax). In the present study, we investigated the clinical significance of incidental prostate uptake by 18F-FDG positron emission tomography (PET)/CT, and examined the differences between malignant and benign uptake from a clinicopathological viewpoint. We reviewed 3,236 male subjects who underwent 18F-FDG PET/CT scans at Hirosaki University Hospital (Japan) from 2008 to 2012 in order to identify cases of incidental prostate FDG uptake. The final diagnosis was made by serum prostate-specific antigen (PSA) levels, biopsy, imaging studies and clinical follow-up with PET findings. Incidental FDG uptake of the prostate was observed in 53 cases (2%). Four cases were excluded due to insufficient clinical data, and 49 cases were included in the present study. Of the 49 cases, 8 (16%) had prostate cancer, while 41 (84%) were benign. All 8 malignant cases had high uptake areas, e.g. in the prostate peripheral zone, where there was no coexistence of calcification or FDG uptake. Of the 41 benign cases, 19 had high uptake in the inner zone, 17 in the peripheral zone, and 5 in both the inner and peripheral zones. Of the 41 cases, 18 (44%) showed FDG uptake coexisting with prostatic calcification. Incidental prostate 18F-FDG uptake infrequently signifies prostate cancer; however, FDG uptake not coexisting with calcification indicates the possibility of prostate cancer and should be included in the differential diagnosis for performing other clinical examinations.

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1	Phelps ME: PET: the merging of biology and imaging into molecular imaging. J Nucl Med. 41:661–681. 2000.PubMed/NCBI
2	Gambhir SS: Molecular imaging of cancer with position emission tomography. Nat Rev Cancer. 2:683–693. 2002. View Article : Google Scholar : PubMed/NCBI
3	Cho SK, Choi JY, Yoo J, Cheon M, Lee JY, Hyun SH, Lee EJ, Lee KH and Kim BT: Incidental focal ¹⁸F-FDG uptake in the prostate: clinical significance and differential diagnostic criteria. Nucl Med Mol Imaging. 45:192–196. 2011.
4	Effert PJ, Bares H, Handt S, Wolff JM, Büll U and Janse G: Metabolic imaging of untreated prostate cancer by PET with ¹⁸fluorine labeled deoxyglucose. J Urol. 155:994–998. 1996. View Article : Google Scholar : PubMed/NCBI
5	Hofer C, Laubenbacher C, Block T, Breul J, Hartung R and Schwaiger M: Fluorine-18-fluorodeoxyglucose positron emission tomography is useless for the detection of local recurrence after radical prostatectomy. Eur Urol. 36:31–35. 1999. View Article : Google Scholar : PubMed/NCBI
6	Takahashi N, Inoue T, Lee J, Yamaguchi T and Shizukuishi K: The roles of PET and PET/CT in the diagnosis and management of prostate cancer. Oncology. 72:226–233. 2007. View Article : Google Scholar : PubMed/NCBI
7	Kao PF, Chou YH and Lai CW: Diffuse FDG uptake in acute prostatitis. Clin Nucl Med. 33:308–310. 2008. View Article : Google Scholar : PubMed/NCBI
8	Liu IJ, Zafar MB, Lai YH, Segall GM and Terris MK: Fluorodeoxyglucose positron emission tomography studies in diagnosis and staging of clinically organ-confined prostate cancer. Urology. 57:108–111. 2001. View Article : Google Scholar : PubMed/NCBI
9	Dong C and Hemminki K: Second primary neoplasms among 53 159 haemotolymphoproliferative malignancy patients in Sweden, 1958–1996 a search for common mechanisms. Br J Cancer. 85:997–1005. 2001.PubMed/NCBI
10	Ueno M, Muto T, Oya M, Ota H, Azekura K and Yamaguchi T: Multiple primary cancer: an experience at the Cancer Institute Hospital with special reference to colorectal cancer. Int J Clin Oncol. 8:162–167. 2003. View Article : Google Scholar : PubMed/NCBI
11	Leön X, Ferlito A, Myer CM III, Saffiotti U, Shaha AR, Bradley PJ, Brandwein MS, Anniko M, Elluru RG and Rinaldo A: Second primary tumors in head and neck cancer patients. Acta Otolaryngol. 122:765–778. 2002.
12	Han EJ, HOJ, Choi WH, Yoo IR and Chung SK: Significance of incidental focal uptake in prostate on 18-fluro-2-deoxyglucose positron emission tomography CT images. Br J Radiol. 83:915–920. 2010. View Article : Google Scholar : PubMed/NCBI
13	Hwang I, Chong A, Jung SI, Hwang EC, Kim SO, Kang TW, Kwon DD, Park K and Ryu SB: Is further evaluation needed for incidental focal uptake in the prostate in 18-fluori-2-deoxyglucose positron emission tomography-computed tomography images? Ann Nucl Med. 27:140–145. 2013. View Article : Google Scholar
14	McNeal JE: The zonal anatomy of the prostate. Prostate. 2:35–49. 1981. View Article : Google Scholar : PubMed/NCBI
15	Kilmas R, Bennett B and Gardner WA Jr: Prostate calculi: a review. Prostate. 7:91–96. 1985. View Article : Google Scholar
16	Eykyn S, Bultitude MI, Mayo ME and Lloyd-Davies RW: Prostatic calculi as a source of recurrent bacteriuria in the male. Br J Urol. 46:527–532. 1974.PubMed/NCBI
17	Meares EM: Infection stones of prostate gland. Laboratory diagnosis and clinical management. Urology. 4:560–566. 1974. View Article : Google Scholar : PubMed/NCBI
18	Cross PA, Bartley CJ and McClure J: Amyloid in prostatic corpora amylacea. J Clin Pathol. 45:894–897. 1992. View Article : Google Scholar : PubMed/NCBI
19	Bock E, Calugi V, Stolfi V, Rossi P, D’Ascenzo R and Solivetti FM: Calcifications of the prostate: a transrectal echographic study. Radiol Med. 77:501–503. 1989.(In Italian).
20	Cohen RJ, McNeal JE, Redmond SL, Meehan K, Thomas R, Wilce M and Dawkins HJ: Luminal contents of benign and malignant prostatic glands: correspondence to altered secretory mechanisms. Hum Pathol. 31:94–100. 2000. View Article : Google Scholar : PubMed/NCBI
21	Luna More S: Argyrophil crystalloids in adenocarcinoma of the prostate. Prostate. 24:309–315. 1993.PubMed/NCBI
22	Luna More S, Florez P, Ayala A, Diaz F and Santos A: Neutral and acid mucins and eosinophilic and argyrophil crystalloids in carcinoma and atypical adenomatous hyperplasia of the prostate. Pathol Res Pract. 193:291–298. 1997.PubMed/NCBI
23	Epstein JI: Diagnostic criteria of limited adenocarcinoma of the prostate on needle biopsy. Hum Pathol. 26:223–229. 1995. View Article : Google Scholar : PubMed/NCBI
24	Lee R, Localio AR, Armstrong K, Malkowicz SB and Schwartz JS: A meta-analysis of the performance characteristics of the free prostate-specific antigen test. Urology. 67:762–768. 2006. View Article : Google Scholar : PubMed/NCBI
25	Wefer AE, Hricak H, Vigneron DB, Coakley FV, Lu Y, Wefer J, Meller-Lisse U, Carroll PR and Kurhanewicz J: Sextant localization of prostate cancer: comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology. J Urol. 164:400–404. 2000. View Article : Google Scholar
26	De Marzo AM, Platz EA, Sutcliffe S, Xu J, Grönberg H, Drake CG, Nakai Y, Issacs WB and Nelson WG: Inflammation in prostate carcinogenesis. Nat Rev Cancer. 7:256–269. 2004.
27	Vral A, Magri V, Montanari E, Gazzano G, Gourvas V, Marras E and Perletti G: Topographic and quantitative relationship between prostate inflammation, proliferative inflammatory atrophy and low-grade prostate intraepithelial neoplasia: a biopsy study in chronic prostatitis patients. Int J Oncol. 41:1950–1958. 2012.
28	McNeal JE, Redwine EA, Freiha FS and Stamey TA: Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol. 12:897–906. 1988. View Article : Google Scholar : PubMed/NCBI