Positron Emission Tomography and Positron Emission Tomography/Computerized Tomography of Urological Malignancies: An Update Review

Purpose

Appropriate imaging in uro-oncology is a crucial component at primary diagnosis, followup and recurrence to achieve an accurate assessment of the disease and determine the most effective treatment. We summarize recent developments in positron emission tomography and positron emission tomography/computerized tomography for prostate, bladder and renal cancer.

Materials and Methods

The recent published literature on positron emission tomography and positron emission tomography/computerized tomography in uro-oncology was searched and reviewed.

Results

For prostate cancer ¹⁸F-fluorodeoxyglucose is not highly effective for primary diagnosis but it has a limited role in staging and recurrence detection. Promising results have been shown by ¹¹C-choline, ¹⁸F-fluorocholine, ¹¹C-acetate and ¹⁸F-fluoride. The role of ¹¹C-methionine, ¹⁸F-fluoro-5-alpha-dihydrotestosterone and anti-1-amino-3-¹⁸F-fluorocyclobutane-1-carboxylic acid remains to be elucidated. For bladder cancer ¹⁸F-fluorodeoxyglucose positron emission tomography is useful for identifying distant metastases but not for detecting primary tumors due to the urinary excretion of ¹⁸F-fluorodeoxyglucose. The role of ¹¹C-choline and ¹¹C-methionine remains to be evaluated further in clinical studies. For renal cancer ¹⁸F-fluorodeoxyglucose is of limited use for primary diagnosis but it has a role in staging and restaging of the disease. More clinical data are needed to investigate the roles of ¹⁸F-fluoromisonidazole and ¹⁸F-fluorothymidine.

Conclusions

Several advances in positron emission tomography and positron emission tomography/computerized tomography for urological cancer have been made in recent years. However, larger clinical trials are needed to establish the role of this imaging method for urological malignancy. In the near future the new radiotracers and further advancement in this imaging technique are expected to improve the performance of positron emission tomography/computerized tomography in uro-oncology.

Key Words: prostate, urinary tract, carcinoma, transitional cell, carcinoma, renal cell, positron-emission tomography

Abbreviations and Acronyms: BPH, benign prostatic hyperplasia, CT, computerized tomography, FACBC, fluorocyclobutane-1-carboxylic acid, FCH, fluorocholine, FDG, fluorodeoxyglucose, FDHT, fluoro-5-alpha-dihydrotestosterone, FLT, fluorothymidine, FMISO, fluoromisonidazole, MR, magnetic resonance, MRI, magnetic resonance imaging, MRS, MR spectroscopy, NPV, negative predictive value, PET, positron emission tomography, PPV, positive predictive value, PSA, prostate specific antigen, RCC, renal cell carcinoma, SPECT, single photon emission CT, SUV, standardized uptake value, TRUS, transrectal ultrasound