Prostate cancer skeletal metastases - superscan

Case contributed by Ammar Ashraf

Presentation

Lower urinary tract symptoms with anorexia, weight loss and bony pains.

Patient Data

Age: 60 years
Gender: Male

Extensive mixed lytic/sclerotic lesions are seen in the whole visualized skeleton. Two expansile mixed lytic-sclerotic rib lesions (right 6th and left 8th ribs) with sunburst periosteal reaction and soft tissue component are also noted. Enlarged prostate gland showing heterogeneous enhancement. Multiple bilateral simple renal cortical cysts. Minimal ascites.

Nuclear medicine

Whole body images show significantly increased radiotracer concentration along the posterolateral left 8th rib and lateral right 6th rib. Focal area of increased radiotracer concentration in the head of left femur, increased tracer uptake in the head of both humeri and non-homogenous tracer uptake in the long bones are also noted. Kidneys are not visualized.

Case Discussion

  • PSA: >2000ug/L (reference range ≤4.000ug/L)
  • transrectal prostate biopsy: multifocal prostatic adenocarcinoma
  • bone marrow biopsy: heavily infiltrated with tumor cells (most probably of prostate origin)
  • based on the history of multifocal prostatic adenocarcinoma with markedly elevated PSA level, diffuse bone metastases on the CT scan and bone marrow infiltration by the tumor cells on bone marrow biopsy, bone scan features are suggestive of superscan

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