A 65 year old male presented with low back pain and weight loss. CT scan
of the abdomen and pelvis showed moth eaten appearance of T12
vertebral body and bulky retroperitoneal, bilateral iliac and left inguinal
lymphoadenopathy, concerning for metastatic disease, without any definite
evidence of the primary.
of the abdomen and pelvis showed moth eaten appearance of T12
vertebral body and bulky retroperitoneal, bilateral iliac and left inguinal
lymphoadenopathy, concerning for metastatic disease, without any definite
evidence of the primary.
Case of the month (04/11): Metastatic Prostate Cancer
FDG PET/CT demonstrated extensive hypermetabolic lymphadenopathy
in the left supraclavicular, mediastinal, and retroperitoneal region
consistent with metastatic disease. Widespread hypermetabolic bone
metastases were also seen. Focal hypermetabolism was also seen in the
prostate, with a maximum standardized uptake value (SUV) of 5.6. The
PSA one month ago was elevated at 11.2 ng/ml. Metastatic poorly
differentiated carcinoma was found on FNA biopsy of the left
supraclavicualar node. Immunohistochemistry showed focal staining with
TTF-1 and rare cells staining with PSA and synaptophysin with negative
staining for CK7, CK20, CEA, p504, CDX2, CD20 and CD56, a pattern
seen in small cell carcinoma of the prostate. Prostate biopsy confirmed
adenocarcinoma with a Gleason’s score of 5+4=9.
in the left supraclavicular, mediastinal, and retroperitoneal region
consistent with metastatic disease. Widespread hypermetabolic bone
metastases were also seen. Focal hypermetabolism was also seen in the
prostate, with a maximum standardized uptake value (SUV) of 5.6. The
PSA one month ago was elevated at 11.2 ng/ml. Metastatic poorly
differentiated carcinoma was found on FNA biopsy of the left
supraclavicualar node. Immunohistochemistry showed focal staining with
TTF-1 and rare cells staining with PSA and synaptophysin with negative
staining for CK7, CK20, CEA, p504, CDX2, CD20 and CD56, a pattern
seen in small cell carcinoma of the prostate. Prostate biopsy confirmed
adenocarcinoma with a Gleason’s score of 5+4=9.
PET/CT is not performed routinely to diagnose or stage prostate cancer,
since the majority of prostate cancers are not FDG avid (1, 2). PET/CT
although is indicated in patients with metastatic disease without a known
primary. Focal hypermetabolism in the prostate is suspicious for neoplasm
and should be further evaluation with tissue sampling to rule out
malignancy. In patients with FDG avid prostate cancer, whole body
PET/CT has been shown to provide additional information by identifying
metastatic lesions (in soft tissues, lymph nodes, and skeleton) with one
single whole body imaging procedure (3,4).
1: Ishiguro T, Kimura H, Araya T, Minato H, Katayama N, Yasui M,
Kasahara K, Fujimura M. Eosinophilic pneumonia and thoracic
metastases as an initial manifestation of prostatic carcinoma. Intern Med.
2008;47(15):1419-23.
2: Von Schulthess GK, Hany TF. Imaging and PET-PET/CT imaging. J
Radiol. 2008 Mar;89(3 Pt 2):438-47.
3: Liu Y. FDG PET-CT demonstration of metastatic neuroendocrine tumor
of prostate. World J Surg Oncol. 2008 Jun 19;6:64.
4: Jadvar H. Prostate cancer: PET with 18F-FDG, 18F- or 11C-acetate,
and 18F- or 11C-choline. J Nucl Med. 2011 Jan;52(1):81-9.
This case was prepared by Dr. David He BCM
since the majority of prostate cancers are not FDG avid (1, 2). PET/CT
although is indicated in patients with metastatic disease without a known
primary. Focal hypermetabolism in the prostate is suspicious for neoplasm
and should be further evaluation with tissue sampling to rule out
malignancy. In patients with FDG avid prostate cancer, whole body
PET/CT has been shown to provide additional information by identifying
metastatic lesions (in soft tissues, lymph nodes, and skeleton) with one
single whole body imaging procedure (3,4).
1: Ishiguro T, Kimura H, Araya T, Minato H, Katayama N, Yasui M,
Kasahara K, Fujimura M. Eosinophilic pneumonia and thoracic
metastases as an initial manifestation of prostatic carcinoma. Intern Med.
2008;47(15):1419-23.
2: Von Schulthess GK, Hany TF. Imaging and PET-PET/CT imaging. J
Radiol. 2008 Mar;89(3 Pt 2):438-47.
3: Liu Y. FDG PET-CT demonstration of metastatic neuroendocrine tumor
of prostate. World J Surg Oncol. 2008 Jun 19;6:64.
4: Jadvar H. Prostate cancer: PET with 18F-FDG, 18F- or 11C-acetate,
and 18F- or 11C-choline. J Nucl Med. 2011 Jan;52(1):81-9.
This case was prepared by Dr. David He BCM
