14 Early experience with positron emission tomography (PET) in the management of urological malignancies

Abstract

Objective: To demonstrate management alterations in patients with urological malignancies by the addition of PET.Patients and Methods: Ten patients with primary urological malignancies were included in this initial series (eight urothelial transitional cell and two penile squamous cell). Conventional imaging of computerised tomography (CT) and / or magnetic resonance imaging (MRI) yielded equivocal staging results pertaining to definitive management. Each patient underwent PET for further staging. Management alterations with respect to PET findings are outlined.Results: Of the 10 patients, five were downstaged and five upstaged with PET. Management changes are tabulated.Conclusion: We demonstrated in this series the role of PET in staging urological malignancies in those patients with equivocal conventional findings. Also, more accurate physiological staging allows better oncological treatment decisions and eventual patient outcome. These points highlighted need further clarification with larger series addressing the positive predictive value of PET. Downstaged TABLE1: for 14 Diagnosis CT / MRI PET Management G2T3 Bladder Pelvic LN Negative Surgery G3T2 Ureter LN at primary Negative Surgery G3T2® UO Pelvic LN Negative Surgery T2 Penis Pelvic LN Negative Surgery T2 Penis Pelvic LN Negative Surgery Upstaged TABLE2: for 14 Diagnosis CT / MRI PET Management G3T2 Ureter Pelvic LN Metastatic Chemotherapy G3T2 Bladder Pelvic LN Metastatic Chemotherapy G3T2 Bladder Pelvic LN Metastatic Radiotherapy G3T4 Bladder N0 M0 Metastatic Chemotherapy G3T3 Bladder Pelvic LN Metastatic Radiotherapy