. 2017; 26(2): 76-82

Clinical significance of 18F-FDG avid prostate gland incidentalomas on PET/CT

William Makis1, Anthony Ciarallo2
1Department of Diagnostic Imaging, Cross Cancer Institute, Edmonton, Canada
2Department of Nuclear Medicine, MUHC Glen Site, Montreal, Canada

INTRODUCTION: The aim of this study was to evaluate the clinical significance of incidental focal uptake of 18F-fluorodeoxyglucose (FDG) on positron emission tomography / computed tomography (PET/CT) in the prostate glands of cancer patients.
METHODS: A retrospective review of 3,122 consecutive 18F-FDG PET/CT studies done for men with an oncologic indication, over the course of four years, was performed. Studies with incidental 18F-FDG uptake in the prostate were further analyzed.
RESULTS: Incidental 18F-FDG uptake in the prostate was identified in 65 / 3,122 men (2.1%). Sufficient follow-up data (≥ 12 months) were available in 53 patients, of whom 11 had a biopsy performed and 42 had clinical and imaging follow-up. Malignancy was histologically diagnosed in 4 of 53 patients (7.5%). There was no statistically significant difference in 18F-FDG uptake between benign prostate lesions (maximum standardized uptake value, SUVmax 7.3) and malignant ones (SUVmax 7.2, p=0.95). There was a statistically significant difference between the serum prostate specific antigen (PSA) of the benign group (n=24, PSA = 2.7 ng/ml), and malignant group (n=4, PSA 9.2 ng/ml, p<0.001). There was a direct correlation between the SUVmax and Gleason score.
DISCUSSION AND CONCLUSION: 18F-FDG positive prostate incidentalomas occurred in 2.1% of oncologic PET/CT scans and of these, 7.5% were malignant. SUVmax was not useful for distinguishing between benign and malignant incidental prostate lesions. 18F-FDG avid prostate incidentalomas on PET/CT should prompt a recommendation for obtaining a serum PSA and further investigation if serum PSA is elevated.

Keywords: prostate incidentaloma, prostate carcinoma, 18F-fluorodeoxyglucose, 18F-FDG, positron emission tomography, PET, PET/CT, PSA


William Makis, Anthony Ciarallo. Clinical significance of 18F-FDG avid prostate gland incidentalomas on PET/CT. . 2017; 26(2): 76-82

Corresponding Author: William Makis, Canada


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