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PET Staging in Kidney, Prostate & Bladder Cancer

Evidence based review of the role of PET and PET/CT in the initial staging and evaluation of kidney, prostate and urinary bladder cancer. Plenary presentation at the Urological Society of India's meeting in Chandigarh, India on Nov. 16, 2013.
by

Gagan Gautam

on 5 February 2014

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Transcript of PET Staging in Kidney, Prostate & Bladder Cancer

Prostate cancer
FDG PET/CT



11C or 18F - Choline PET/CT
PET CT Staging
Kidney cancer
Prostate cancer
Bladder cancer

Take home messages
No data to recommend FDG PET/CT for initial staging of kidney, prostate & bladder cancer

Promise of future clinical utility from newer tracers
Gagan Gautam
SUV = Tissue radioactivity concentration/Injected activity divided by the body weight

2.0 - 2.5: Cut off for malignant vs benign
FDG PET/CT
Low uptake due to low glycolysis rates

Poor sensitivity

False positive in BPH/prostatitis

Urinary excretion of FDG

Not recommended
Hacker, J Urol 2006
FDG PET
~ 50% primaries not visible with FDG
Sensitivity 47 - 75% (CT: 91%)
Specificity 75 - 100%
Unable to detect metastases < 1cm
Lack of data
Most studies in pre PET/CT era

Kidney cancer
FDG PET/CT

G250 PET/CT
G250 PET/CT
Monoclonal antibody to CA IX
Selective for clear cell RCC
Sensitivity 94%
Specificity 100%
Implications
Staging
Follow up
Selection for active surveillance
Radio-immunotherapy
Majhail, J Clin Oncol 2003
Jadvar, Clin Nephrol 2003
Aide, Eur J Nucl Med Mol Imaging 2003
Divgi, Lancet Oncol 2007
Choline PET/CT - Local evaluation
Rapid uptake prior to urinary excretion
Sensitivity 55 - 100%
Specificity 43 - 87%

*Sensitivity only 4% for lesions < 5mm
False positive in BPH/PIN/Prostatitis
Inferior to eMRI/MRS for ECE (22% vs 63%)
Kitajima, Ann Nucl Med 2013
Choline PET/CT - Detection of lymph node metastases


Improved performance over CT/MRI
(CT/MRI: Sensitivity 39%, Specificity 82%)

*Cannot replace PLND
Size dependent
(Sensitivity < 33% for LN < 1cm)
Kitajima, Ann Nucl Med 2013
Choline PET CT - Evaluation of BCR
Sensitivity: 41 - 100%
Specificity: 36 - 100%
Sensitivity: 0 - 78%
Specificity: 80 - 100%
FDA approved
Sensitivity dependent on PSA level
PSA Sensitivity
< 1 20%
1 - 5 44%
>5 80%
Kitajima, Ann Nucl Med 2013
Bladder cancer
FDG PET/CT
Lymph node staging
No evidence of advantage over CT
Not recommended
Sensitivity: 82%
Specificity: 89%
Evaluation for distant metastases
Lack of data
Accumulating evidence of benefit
May be included in future guidelines
EAU guidelines, 2013
Head of Urologic Oncology & Robotic Surgery
Full transcript