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Granulomatous Prostatitis After Intravesical Bacillus Calmette-Guérin Instillation Therapy: A Potential Cause of Incidental F-18 FDG Uptake in the Prostate Gland on F-18 FDG PET/CT in Patients with Bladder Cancer

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Abstract

Purpose

This study aimed to evaluate the possibility that Bacillus Calmette-Guérin (BCG)-induced granulomatous prostatitis can be a potential cause of benign F-18 FDG uptake.

Methods

A total of 395 bladder cancer patients who underwent F-18 FDG PET/CT (PET/CT) were retrospectively evaluated. Patients were divided into two groups according to BCG therapy status. Elapsed time after BCG therapy, serum PSA level, results of prostate biopsy, and the SUVmax and uptake pattern in the prostate gland were reviewed. For patients who underwent follow-up PET/CT, the changes in SUVmax were calculated.

Results

While 35 % of patients showed prostate uptake in the BCG therapy group, only 1 % showed prostate uptake in the non-BCG therapy group (p < 0.001). Among 49 patients with FDG-avid prostate lesions, none had suspected malignancy during the follow-up period (median: 16 months). Five patients revealed granulomatous prostatitis on biopsy. The incidence of FDG-avid prostate lesions was significantly higher if the elapsed time after BCG therapy was less than 1 year compared to more than 1 year (p < 0.001). Serum PSA was normal in 88 % of patients. All patients with incidental F-18 FDG uptake in the prostate gland showed focal or multifocal prostate uptake, and median SUVmax was 4.7. In 16 patients who underwent follow-up PET/CT, SUVmax was decreased in 14 patients (88 %) without treatment, and no patients demonstrated further increased prostate uptake (p < 0.001).

Conclusions

BCG-induced granulomatous prostatitis can be a potential cause of benign F-18 FDG uptake, especially in those with a history of bladder cancer treated with BCG. In BCG-induced granulomatous prostatitis, focal or multifocal prostate uptake is frequently seen within 1 year after BCG therapy, and the intensity of prostate uptake is decreased on the follow-up PET/CT without any treatment.

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Conflict of interest

Choon-Young Kim, Sang-Woo Lee, Seock Hwan Choi, Seung Hyun Son, Ji-hoon Jung, Chang-Hee Lee, Shin Young Jeong, Byeong-Cheol Ahn, and Jaetae Lee declare that they have no conflicts of interest.

This manuscript has not been published before and is not under consideration for publication anywhere else. It has been approved by all co-authors.

Ethics Statement

This study was approved by the Institutional Review Board of Kyungpook National University Medical Center and School of Medicine, and the requirement for written informed consent was waived. This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Kyungpook National University Medical Center and School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea

    Choon-Young Kim, Sang-Woo Lee, Seung Hyun Son, Ji-hoon Jung, Chang-Hee Lee, Shin Young Jeong, Byeong-Cheol Ahn & Jaetae Lee

  2. Department of Urology, Kyungpook National University Medical Center and School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea

    Seock Hwan Choi

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  1. Choon-Young Kim
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  8. Byeong-Cheol Ahn
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  9. Jaetae Lee
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Correspondence to Sang-Woo Lee.

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Kim, CY., Lee, SW., Choi, S.H. et al. Granulomatous Prostatitis After Intravesical Bacillus Calmette-Guérin Instillation Therapy: A Potential Cause of Incidental F-18 FDG Uptake in the Prostate Gland on F-18 FDG PET/CT in Patients with Bladder Cancer. Nucl Med Mol Imaging 50, 31–37 (2016). https://doi.org/10.1007/s13139-015-0364-y

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  • DOI: https://doi.org/10.1007/s13139-015-0364-y

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