Abdominal aortic aneurysm in prostate cancer patients: the “road map” from incidental detection to advanced predictive, preventive, and personalized approach utilizing common follow-up for both pathologies
Abdominal aortic aneurysm (AAA) is often a hidden pathological process showing no clinical symptoms. Genetic burden, smoking, male gender, age > 65 years, and white race have been identified as the main risk factors. A regular screening program has been introduced but is, as yet, unclear and is not performed in most countries. Prostate cancer is the most frequent male malignant disease in Western countries. Prostate cancer is a disease of older age with a median primary diagnosis of over 60 years. In recent years, advanced imaging methods have been established as important diagnostic tools in prostate cancer diagnostics. The incidental detection of AAA during diagnostic imaging performed due to prostate cancer diagnosis could reveal some asymptomatic aneurysms. Using our experience, the incidental detection of AAA during 18F-fluoromethylcholine PET/CT imaging, performed due to the staging, follow-up, and restaging of the prostate cancer, was reworked into a regular tool of secondary prevention within the framework of personalized medicine strategies. Experience with this type of AAA detection is demonstrated by a cohort of 500 patients who underwent 18F-fluorometylcholine PET/CT examination due to the staging or restaging of prostate cancer. A total of 28 aneurysms were detected (26 aneurysms < 50 mm, 2 aneurysms > 50 mm). In 2 cases (diameter < 50 mm), serious complications were found (penetrating aortic ulcer). The detection and monitoring of AAA in patients undergoing 18F-fluorometylcholine PET/CT due to the prostate cancer offers the possibility of a secondary prevention of AAA, patient stratification, and common follow-up for both pathologies.
Abdominal aortic aneurysm Prostate cancer 18F-fluorometylcholine Iodine contrast agent PET/CT Personalized follow-up Predictive value of imaging methods Patient stratification Screening Primary prevention Secondary prevention Prognosis Diagnostic algorithm Androgen deprivation Rupture Incidence Diameter Risk factors General population Stent graft placement Multivariate model Biomarker panel American Association for Vascular Surgery Society for Vascular Surgery
Abdominal aortic aneurysm
Age-standardized incidence rate
The age-standardized mortality rate
Digital rectal examination
Human development index
Magnetic resonance imaging
Positron emission tomography
Prostate specific antigen
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This study was supported by a Grant from the Czech Health Research Council No.15-32727A and by the Ministry of Health, Czech Republic-Conceptual Development of Research Organization (University Hospital in Pilsen-FNPl, 00669806).
Compliance with ethical standards
The authors declare that they have no competing interests.
All investigations conformed to the principles outlined in the Declaration of Helsinki. Informed consent was obtained from all the participants. The study was approved by the responsible Ethical Committee of the University Hospital in Pilsen on 12th of August 2014.
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