Detecting Metastatic Pelvic Lymph Nodes by ¹⁸F-2-Deoxyglucose Positron Emission Tomography in Patients with Prostate-Specific Antigen Relapse after Treatment for Localized Prostate Cancer

Abstract

Aim: To evaluate whether positron emission tomography (PET) with ¹⁸F-2-deoxyglucose (FDG) can detect pelvic lymph node metastases in prostate cancer patients who had elevated serum prostate-specific antigen (PSA) levels after treatment. Methods: Twenty-four patients with a rising serum PSA level after treatment for localized prostate cancer were examined with FDG-PET before pelvic lymph node dissection. All patients had negative findings on whole body bone scan and equivocal pelvic computed tomography (CT) results. The results of FDG-PET were then compared to the histology of the pelvic lymph nodes obtained at surgery. Results: Lymph node metastases were detected by histopathological examination in 16/24 (66.7%) patients. At the sites with histopathologically proven metastases, increased FDG uptake was found in 12/16 (75.0%) patients. In addition, there were 4 patients with false-negative results, but no patient with a false-positive result on FDG-PET images. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET in detecting metastatic pelvic lymph nodes were 75.0, 100.0, 83.3, 100.0, and 67.7%, respectively. Conclusions: These results suggest that FDG-PET may be a valuable diagnostic tool in the staging of pelvic lymph nodes in patients with PSA relapse after treatment of localized prostate cancer when the whole body bone scan is negative and pelvic CT findings are equivocal.

18F-fluorodeoxyglucose PET/CT for detection of disease in patients with prostate-specific antigen relapse following radical treatment of a local-stage prostate cancer

“…In the study, either local recurrence or systemic metastases were found in 31% of the patients undergoing FDG-PET due to PSA recurrence. In another study on 24 patients with verification of the pelvic lymph nodes, Chang et al (28) found a sensitivity, specificity, positive predictive value and negative predictive value of 75, 100, 100 and 67.7%, respectively. In the study, it was demonstrated that FDG-PET could detect metastatic disease in ~31% of the patients with PSA recurrence following RP.…”

PET of Glucose Metabolism and Cellular Proliferation in Prostate Cancer

“…It has often been stated that 18 F-FDG PET is not useful in prostate cancer. However, this belief seems to have arisen from some early studies in which 18 F-FDG PET was interrogated in the setting of primary tumor diagnosis or staging of the disease, for which the overall results were unsatisfactory (1)(2)(3).…”

“…However, this belief seems to have arisen from some early studies in which 18 F-FDG PET was interrogated in the setting of primary tumor diagnosis or staging of the disease, for which the overall results were unsatisfactory (1)(2)(3). The utility of 18 F-FDG PET appears to depend on the phase of the disease; therefore, it may be quite relevant in one phase of the disease but limited in another phase (4,5).…”

“…The Warburg effect is a hallmark of cancer and can be reliably interrogated with PET and 18 F-FDG. In fact, 18 F-FDG PET has now become the mainstay for the imaging evaluation of several cancers. Another important biologic feature in cancer is cellular proliferation.…”

Is there a role for positron emission tomography imaging in the early evaluation of prostate cancer relapse?

“…Other recent reports suggest that Prostascint is not fulfilling its promise and is of little incremental value in selecting patients with local recurrence who may be salvaged by radiotherapy. 50 Chang et al 51 evaluated the role of 18 F-FDG-PET in patients with rising PSA following treatment for localized prostate cancer who had a negative bone scan. Patients underwent lymph-node dissection following PET.…”