I recently completed a PET/CT Merge Scan and the results indicated "Abnormal uptake in both lobes of the prostate, greater on the right. Clinical correlation and further evaluation is suggested as prostate neoplasm can have the presentation on PET."
After discussing the results with my Urologist, we decided to follow the watchful waiting approach, since I am not interested in a prostate biopsy at this point in time.
However, I have some concern about whether I have a slow- or fast-growth prostate cancer. After doing some research, there appears to be an ultrasound technology called Power Doppler Imaging that is much more sensitive than the traditional Color Doppler and can be used for some degree for diagnosis. The unit I have seen mentioned is the GE Voluson 730.
Has anyone had this type of ultrasound scan? If so, I would appreciate any thoughts, comments, and suggestions.
PET scanning (positron emission technology) has not been approved for use in prostate cancer. In fact, it is not on the approved list from Medicare for diagnoses that are reimbursable for this technology. PET is a nuclear medicine technique using a camera that captures images of the human body's function. Compounds normally existing in the body, like simple sugars, are labeled with radioactive tracers, which emit signals and are injected into the body intravenously. The scanner records the signals that the tracer emits as it journeys through the body and as it collects in targeted organs. The images are computer-reassembled into actual images, which then show a biological map.
I recently was posed with the same diagnostic dilemma in a patient who presented a PET scan that was done for another primary malignancy and it detected an abnormality in one lobe of the prostate. In this patient it was very important to determine if there was underlying prostate cancer, since the treatment for the other malignancy would be altered if the patient did indeed have prostate cancer. The patient had a normal PSA, and underwent a transrectal ultrasound guided biopsy of the prostate which did not demonstrate the present of malignancy, despite the abnormal PET scan.
Power Doppler Imaging (regardless of the machine utilized) is a test which is in its infancy, that some have tried to apply to the diagnosis of prostate cancer. It differs in the fact that it provides information regarding the vascularity of the prostate. The thought is that any malignancy will be hypervascular compared to normal tissue surrounding it, and will thus result in targeted biopsies. Its validity has not yet been well substantiated. A recent study from the University of Pennsylvania has revealed that this imaging technique does not provide further resolution of tumor identification over multiple biopsies of the prostate.
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