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PSMA Case: Initial Staging, High Risk Prostate Cancer

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This is a case of a 76-year-old male

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that had a recently diagnosed

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Gleason nine prostate adenocarcinoma

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and his most recent PSA was 56.

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So this patient has high risk prostate cancer and

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therefore PSMA PET CT was performed for staging.

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We can see in the meep

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that here in the prostate gland there is

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large volume of disease.

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The intensity of the tracer is really high

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and the tracer is essentially occupying the majority

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of the prostate gland as far as extension

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beyond the prostate gland into the seminal vesicles.

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That is possible on the lip side, as you can see here,

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uh, with this focal uptake overlying the seminal vesicle.

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Moving on to the NOLA staging for this patient.

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There's multiple areas on the ME imaging that you can see

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that have focal uptake, so let's localize those.

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We have an intensely PSMA AVID right

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ator lymph node right when the external

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and internal iliac vasculature divides.

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That is consistent with no involvement,

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but we also have involvement on the contralateral side

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with much less intensity,

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similarly in other smaller lymph nodes in the left side

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of the pelvis as well.

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Notice these focus of uptake

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and tear lead that have a very faint correlate on the ct.

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That's an additional lymph node.

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And then higher up, we're gonna look at the retroperitoneum

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and posterior mediastinum to ensure

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that there are no additional sites of another disease along

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that pathway, which there isn't probably.

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You have identified there is a focus

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of uptake in this vert body

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that has a very faint correlate on the ct,

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and this is consistent with a single

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osseous metastasis on this patient.

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So aside from those lymph nodes that were involved,

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there's a couple of areas that show focal tracer uptake.

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This one is localizing to the S one

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and has a CT correlate with an CLE ticus,

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and the second side of disease is here at L two

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vertebral body, also with a faint sclerotic lesion on ct.

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There were no other sites

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of distant disease in this patient.

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So to recap, disease, a patient with

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clinical high risk prostate cancer that has large volume

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of disease in the prostate gland with possible involvement

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of the left semial, vesco, bilateral pelvic

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novel involvement, as well as two sides

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of OS osteos metastatic disease.

Report

Faculty

Elisa Franquet Elia, MD

Assistant Professor of Radiology

UMass Chan Medical School

Tags

Prostate/seminal vesicles

PET/CT PSMA

PET

Oncologic Imaging

Nuclear Medicine

Neoplastic

Genitourinary (GU)