General NM case of the month (10/09): Metastatic Prostate Cancer
This case was compiled by Dr. Vivek Bansal, BCM
A 47 years old Caucasian male with a history of metastatic prostate adenocarcinoma
(diagnosed 2 years ago when he presented with obstructive uropathy and elevated
PSA, had retroperitoneal lymphadenopathy and Gleason score of 5+5=10, highest
grade, was treated with chemotherapy and androgen blockade with good response)
presented with rising PSA (increase from 0.1 to 10.1 ng/ml), despite radiographic
improvement in the prostate on recent CT and a negative whole body bone scan.
Currently, no urinary or GI complaints.
(diagnosed 2 years ago when he presented with obstructive uropathy and elevated
PSA, had retroperitoneal lymphadenopathy and Gleason score of 5+5=10, highest
grade, was treated with chemotherapy and androgen blockade with good response)
presented with rising PSA (increase from 0.1 to 10.1 ng/ml), despite radiographic
improvement in the prostate on recent CT and a negative whole body bone scan.
Currently, no urinary or GI complaints.
A Prostascint study was ordered to determine the cause of the rising PSA. Five days
after the injection of 7.0 mCi of In-111 Capromab pendetide (prostascint - Indium
labeled monoclonal antibody that reacts with (PSMA) prostate specific membrane
antigen) whole body images were acquired in anterior and posterior projections and
SPECT-CT images of the abdomen and pelvis were acquired. Unlike PSA, PSMA is
a membrane glycoprotein that correlates with the aggressiveness of malignancy. It is
expressed in all prostate tissue, malignant and benign. The conjugated antibody
also binds duodenal epithelial cells and proximal tubule cells in the kidney.
after the injection of 7.0 mCi of In-111 Capromab pendetide (prostascint - Indium
labeled monoclonal antibody that reacts with (PSMA) prostate specific membrane
antigen) whole body images were acquired in anterior and posterior projections and
SPECT-CT images of the abdomen and pelvis were acquired. Unlike PSA, PSMA is
a membrane glycoprotein that correlates with the aggressiveness of malignancy. It is
expressed in all prostate tissue, malignant and benign. The conjugated antibody
also binds duodenal epithelial cells and proximal tubule cells in the kidney.
On SPECT-CT images, ProstaScint uptake is noted in prostate gland and in several
retroperitoneal lymph nodes, particularly in the left para-aortic region. There are
also foci of increased uptake in the central abdomen and left upper quadrant, which
correspond to mesenteric lymph nodes.
retroperitoneal lymph nodes, particularly in the left para-aortic region. There are
also foci of increased uptake in the central abdomen and left upper quadrant, which
correspond to mesenteric lymph nodes.
1. Manyak MJ. Indium-111 capromab pendetide in the management of recurrent
prostate cancer. Expert Rev Anticancer Ther. 2008 Feb;8(2):175-81.
2. Chang, SS. Overview of Prostate-Specific Membrane Antigen. Rev Urol. 2004; 6
(Suppl 10): S13–S18.
prostate cancer. Expert Rev Anticancer Ther. 2008 Feb;8(2):175-81.
2. Chang, SS. Overview of Prostate-Specific Membrane Antigen. Rev Urol. 2004; 6
(Suppl 10): S13–S18.
