Prostatic incidental uptake on PET/CT: an updated systematic review and meta-analysis of prevalence and malignancy...

Prostatic incidental uptake (PIU) may have clinical relevance, and progress in molecular imaging is likely to increase its detection. This study aimed to provide updated pooled estimates of the prevalence and malignancy risk of PIU identified on [18F]FDG positron emission tomography/computed tomography (PET/CT) and on PET/CT scans using radiotracers other than [18F]FDG.

A comprehensive search for studies on PIU was performed in two databases, screening all available literature up to 30 October 2025. Only original articles reporting PIU were included. A proportion meta-analysis was conducted on a patient-based analysis using a random-effects model to calculate pooled prevalence and malignancy rates. In addition, several variables were evaluated as potential predictors of malignant PIU.

Twenty-four studies met the inclusion criteria. PET/CT was performed with [18F]FDG in 23 studies and with radiolabeled somatostatin analogues (SSA) in one study. The pooled prevalence of PIU was 1.7% for [18F]FDG PET/CT, whereas the prevalence observed in the single eligible SSA PET/CT study was 4.5%. The pooled malignancy rates among PIU cases that underwent further evaluation or biopsy were 21.3% and 59.7%, respectively; no malignant lesions were reported in the SSA study. Malignant PIUs showed a higher mean age and a higher mean SUVmax compared with benign PIUs. A peripheral location of PIU emerged as a predictor of malignancy.

PIU is detected in approximately 1.7% of [18F]FDG PET/CT scans in men and is associated with a relevant risk of malignancy. Accordingly, PIU should prompt individualized clinical correlation, particularly when uptake is focal, peripherally located, or associated with elevated PSA or other suspicious prostate-directed findings. More well-designed studies are required to better define the clinical impact of PIU and to determine its prevalence and clinical relevance when using PET tracers other than [18F]FDG.