PET in the management of urologic malignancies

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Prostate cancer

Carcinoma of the prostate is the second most common cause of death from cancer among men in America. The incidence of disease is likely to increase with improved detection and public awareness. Optimal treatment of this cancer depends on the accurate staging of the disease at the time of presentation. Localized primary or recurrent prostate cancer can be treated with radical prostatectomy [5]. Chemotherapy, immunotherapy, or hormonal therapies are the most frequent choices of treatment of

Testicular cancer

Testicular cancer is the most common tumor of young men and its incidence is increasing [35]. Seminoma and nonseminoma germ cell tumors (NSGCTs) have different biologic behaviors. Most patients with minimal metastatic disease can be cured with chemotherapy. NSGCTs with stage I disease does not require chemotherapy and can be followed-up clinically for progression.

Diagnosis and staging

Despite significant uptake and excretion through the kidneys, FDG has been used in the diagnosis and management of renal cell carcinoma (RCC). Bachor et al [53] studied 29 patients with solid renal masses and found that PET was positive in 20 (77%) of 26 patients of RCC. PET was false-negative in the remaining six patients; and it was false-positive in an angiomyolipoma, a pericytoma, and a pheochromocytoma. Ramdave et al [54] evaluated the accuracy of FDG-PET for staging and management of 17

Bladder cancer

Physiologic excretion of FDG in urine results in much difficulty in detecting lesions in the bladder and adjacent lymph nodes. FDG-PET has a limited use in diagnosis and management of bladder cancer. Kosuda et al [60] studied 12 patients with FDG-PET for the evaluation of recurrent or residual disease. PET identified 100% (17 of 17) of distant metastases (lung, bones, and remote lymph nodes) and 67% (2 of 3) of local lymph nodes. Heicappell et al [14] also had similar detection rate of 67% for

Summary

FDG-PET has a limited role in the diagnosis of prostate cancer mainly because of the low uptake of FDG in the tumor and normal excretion of FDG through urine. FDG-PET has shown some promise in the assessment of lymph nodes and bone metastases. There is a large degree of variability when FDG-PET is compared with bone scintigraphy. New C11-labeled radiotracers (acetate, choline, and methionine) have shown promising initial results but further studies are required to determine their role in such

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