Incidental Myocardial Uptake in Patients with Prostate Cancer: A Challenging Subject

Background: Countless confounding factors have been described in the interpretation of incidental myocardial uptakes. Among them, prostate cancer is probably the most important. While some authors may defend the benign etiology of these uptakes, others propose a further study to rule out amyloid cardiomyopathy. Objective: Our aim is to investigate the clinical relevance of incidental myocardial uptakes in bone scans requested to evaluate prostatic neoplasia, assessing the possibility that the described uptakes correspond to cardiac amyloidosis (CA). Methods: Retrospective revision of 997 patients, 20 of which showed incidental myocardial uptake. We performed a cardiological study in these 20 patients in order to indicate whether the myocardial uptake is just attributable to prostate cancer or data suggesting CA. Results: By analysing clinical, biochemical and imaging data, 11 out of 20 of the patients had two or more Red-Flags of transthyretin amyloid cardiomyopathy (ATTR-c). In the other four cases, there was one Red-Flag suggestive of ATTR-c. Conclusions: When myocardial uptake is detected incidentally in patients with prostate cancer, it cannot be attributed to the neoplasm itself before ruling out cardiac amyloidosis. Therefore, a cardiological study must be carried out following current protocols for the diagnosis of transthyretin amyloid heart disease.