Advances in Urology

Review Article

Dual-Tracer Positron-Emission Tomography Using Prostate-Specific Membrane Antigen and Fluorodeoxyglucose for Staging of Prostate Cancer: A Systematic Review

Table 2

Summary of case report data, considering use at different stages of prostate cancer (PCa) including primary staging, recurrent disease, and castrate-resistant PCa.


Ref.	Reason for dual-tracer PET	Avidity pattern	Metastatic/localised	Histology	PSMA+ lesions	FDG+ lesions	PSA	Gleason score

A-primary staging
[34]	Staging for ductal variant	PSMA+ FDG+ discordant	L	Ductal	Prostate, mild bilaterally	Prostate, extensively in the left lobe	0.2	4 + 5 = 9
[35]	Synchronous rectal cancer and PCa	PSMA+ FDG+ discordant	L	Adenocarcinoma	Prostate	Rectum, presacral lymph node	37	Not documented
[36]	High-grade histology, low PSMA avidity of the prostate, equivocal staging	PSMA+ FDG+ discordant	M	Adenocarcinoma	Pelvic lymph nodes, T8 vertebrae	Prostate, pelvic lymph nodes, T8 vertebrae, right acetabulum	16.3	5 + 5 = 10
[37]	Infection vs. locally advanced disease in frail elderly patient	PSMA+ FDG−	M	Neuroendocrine (presumed)	Prostate, bladder	None	49	No histology
[38]	Staging for neuroendocrine PCa	PSMA− FDG+	M	Neuroendocrine	None	Prostate, bladder, rectum, lymph nodes, bone	163	5 + 4 = 9

B-restaging of the recurrent disease
[34]	BCR in ductal variant with lung nodules	PSMA− FDG+	M	Ductal	None	Lung	5.9	4 + 5 = 9
[39]	BCR with lung nodules	PSMA− FDG+	M	Ductal	None	Lung	0.59	Not documented
[40]	Neuroendocrine transformation	PSMA+ FDG+ discordant	M	Neuroendocrine	Bone	Bone, left pelvic soft tissue, penis	8	4 + 3 = 7
[41]	BCR with lung nodules	PSMA+ FDG+ discordant	M	Adenocarcinoma	Two lung nodules	One lung nodule	0.275	Not documented
[42]	BCR with lung nodules	PSMA+ FDG+ discordant	M	Adenocarcinoma Sarcomatoid metastasis	Pelvic lymph node, lung	Lung	4.63	4 + 4 = 8
[43]	BCR with lung nodules	PSMA+ FDG−	M	Adenocarcinoma Mucinous metastasis	Lung	None	0.2	4 + 3 = 7
[44]	BCR with negative FDG PET	PSMA+ FDG−	M	Adenocarcinoma	Mediastinal lymph nodes	None	7.1	4 + 4 = 8

C-castrate-resistant prostate cancer
[45]	Onset of castration resistance with unclear FDG PET	PSMA+ FDG+ discordant	M	Not documented	Prostate, bone, pelvic lymph nodes	Prostate, mild bone avidity	10	Not documented
[46]	Onset of castration resistance with adrenal mass	PSMA+ FDG+ concordant	M	Adenocarcinoma	Right adrenal mass	Right adrenal mass	1.9	4 + 5 = 9