Prostate Cancer - 77-year-old gentleman with prostatic carcinoma

History
This is a 77-year-old gentleman with prostatic carcinoma. Needle core biopsy, November 2004, was positive for adenocarcinoma. This examination was requested to stage the patient.

Procedure
The patient's fasting blood glucose was 85. The patient was positioned in the ECAT Reveal XVI (LSO PET/16 slice CT) scanner 81 minutes after injection. A noncontrast CT scan was obtained for attenuation correction, then an emission scan from the forehead to upper thighs was obtained in 7 bed positions over 32 minutes. Images were corrected for signal attenuation and reviewed in the transaxial, coronal and sagittal planes.

Dosage
15.6 mCi 2-[F-18]-fluoro-2-deoxyglucose (FDG) I.V.

PET/CT Findings
Attenuation-corrected PET scan shows normal radiotracer uptake in the visualized brain. There is normal uptake in the oro- and nasopharynx, paranasal sinuses, neck, supraclavicular regions, and axillae. There are 4 foci of increased radiotracer uptake in the hila and mediastinum: There is a focus in the AP window, 2 foci in the right hilum, and a focus in the subcarina inferior to the right mainstem bronchus. The lung fields are clear. There is relatively uniform radiotracer uptake in the liver and spleen, normal uptake in the gastric walls, and no abnormal uptake in the adrenal glands. There is normal excretion of radiotracer through both kidneys. Normal loops of bowel are seen in the abdomen and pelvis. There is normal uptake in the retroperitoneum, iliac, and inguinal regions. The enlarged prostate gland is seen in the noncontrast CT scan obtained for attenuation correction. There are no foci of increased radiotracer uptake seen in the enlarged prostate gland.

Impression
Findings in the hila and mediastinum highly suspicious for metastases. No focal areas of increased radiotracer uptake are seen in the prostatic bed, the primay lesion could be below image resolution of the scanner. There is no evidence of metastasis to the skeleton from the prostatic carcinoma. The sensitivity of PET for prostatic carcinoma primary and metastases is lower than other carcinomas.

Courtesy of
Northern California PET Imaging Center