Presentation
Rising PSA. Previously treated prostate cancer.
Patient Data
Intense PSMA avidity throughout the prostate, consistent with local recurrence of treated prostate cancer. Fiducials in situ from prior radiotherapy.
Several PSMA expressing lymph nodes in the mesorectal fat and pre-sacral region.
Extensive PSMA expressing skeletal lesions throughout the axial and proximal appendicular skeleton, including several large skeletal lesions in the pelvis. Abnormal nodularity and soft tissue density throughout the omentum (right > left) with intense tracer uptake consistent with peritoneal disease. Several PSMA expressing metastatic soft tissue deposits in the penis.
Severe bilateral hydronephrosis, questionably related to obstruction from primary prostate cancer. Small volume ascites. Previous plate and screw fixation of the left proximal humerus.
Case Discussion
This patient was diagnosed with progressive metastatic prostate cancer. The previous PSMA PET-CT demonstrated avid disease within the prostate and pelvic nodes only. In this study, he was found to have new metastatic disease throughout the skeleton, peritoneal/omentum and penis.
PSMA PET-CT is a hybrid functional and anatomical imaging technique with excellent diagnostic utility in patients with prostate cancer. Prostate-specific membrane antigen (PSMA) localizes to a protein present on the surface of well-differentiated prostate cancer cells, with the imaging technique offering superior sensitivity and specificity to conventional imaging modalities.
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