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.