Targeted Prostate Gland Biopsy With Combined Transrectal Ultrasound, mpMRI, and 18F-FMAU PET/CT.

We report on a 61-year-old man with elevated serum prostate-specific antigen level of 10.5 ng/mL who had undergone prior negative standard transrectal ultrasound biopsy at another institution. He was referred to our medical center for evaluation and underwent a clinical 3-T multiparametric MRI and a research protocol PET/CT with the cellular proliferation radiotracer (18)F-FMAU (2'-deoxy-2'-[(18)F]fluoro-5-methyl-1-β-D-arabinofuranosyluracil). The PET/CT and multiparametric MRI were fused with transrectal ultrasound images for real-time hybrid image-based targeting of the biopsy needle. PET/CT with (18)F-FMAU was helpful in localizing the nonstandard biopsy sites that on histopathology revealed suspected tumor deposits.