Abstract
The role of 2-deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in the management of prostate cancer (PCa) patients is increasingly recognised. However, its clinical role is still controversial. Many published studies showed that FDG PET/CT might have a prognostic value in the metastatic castration-resistant phase of the disease, but its role in other settings of PCa and, more importantly, its impact on final clinical management remains to be further investigated. We describe a series of six representative clinical cases of PCa in different clinical settings, but all characterised by a measurable clinical impact of FDG PET/CT on the patients’ management. Starting from their clinical history, we report a concise narrative literature review on the advantages and limitations of FDG PET/CT beyond its prognostic value in PCa. What emerges is that in selected cases, this imaging technique may represent a useful tool in managing PCa patients. However, in the absence of dedicated studies to define the optimal clinical setting of its application, no standard recommendations on its use in PCa patients can be made.
Highlights
Prostate cancer (PCa) is the most common malignancy and the second most frequent cause of cancer-related death among the male population in Western Countries [1]
Oyama et al, showed that following androgen deprivation therapy (ADT), the greater is the reduction in Fluorodeoxyglucose [18F] (FDG) uptake, the deeper is the reduction in serum prostate antigen (PSA) [30]
As the above cases exemplify, FDG Positron Emission Tomography (PET) may be a useful tool in managing patients with PCa at different time points of clinical history such as diagnosis, staging, systemic treatment selection, and evaluation of response
Summary
Prostate cancer (PCa) is the most common malignancy and the second most frequent cause of cancer-related death among the male population in Western Countries [1]. Clinical management may range from active surveillance in low-risk tumours to definitive treatment (radiation therapy/radical prostatectomy) in locoregional ones, up to systemic therapies for patients with advanced disease [2,3]. Due to this wide range of biological behaviour, accurate diagnostic tools for disease diagnosis and staging and assessing tumour aggressiveness is fundamental to support clinical decisions and improve PCa patients’ management. A large part of the published studies showed that FDG imaging might be useful mainly because of its prognostic value in the metastatic castration-resistant phase of the disease (mCRPC) [11,14,15,16]. Starting from the clinical history of emblematic clinical cases, we report a concise narrative literature review on the potential diagnostic uses of FDG PET in PCa, beyond its prognostic value
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