0:00

This is a 57-year-old male that was diagnosed with a high

0:05

risk prostate adenocarcinoma with a Gleason

0:10

score seven and most recent PSA 20,

0:16

this patient under when an F 18 PSMA that I'm showing, uh,

0:19

here in the case we identify large volume

0:24

of disease in the right side of the prostate

0:28

that is predominantly in the posterior aspect

0:30

of the prostate, but also extends

0:33

beyond the expected location of the peripheral zone.

0:37

There is a question of extension,

0:40

more anteriorly in the center of the prostate

0:43

and also is likely on the left, as well as a focus

0:47

of uptake at the base of the left semial vesicle on these,

0:52

uh, baseline PSMA pet, the patient didn't have any

0:56

nodal disease in the pelvis or elsewhere,

0:59

and there was no evidence of, uh, disease

1:02

outside of the pelvis.

1:04

So he underwent prostatectomy.

1:07

His PSA decreased, but it never completely declined.

1:12

The lowest PSA for him was zero point 24,

1:17

and subsequently it started to rise again

1:21

with the most recent one being 0.9.

1:24

So he underwent a second PSMA

1:28

for restaging to identify where the disease was present.

1:33

And as you can see, we have

1:36

no abnormal uptake at the surgical side,

1:39

but there is a focus of

1:42

mild PSMA uptake in the right pelvic that corresponded

1:47

to a small lymph node.

1:49

Mm-Hmm. And that's the internal iliac territory? Mm-Hmm.

1:53

So this was the only site where there was, uh,

1:57

still p sm a AVID disease.

1:59

And this was a thought to represent the disease

2:04

that was driving the PSA levels.

2:07

Taking a closer look, we can see

2:09

that these actually corresponds to a lymph node

2:12

as I scroll up and down.

2:14

Um, it doesn't track

2:16

and it doesn't correspond to the ureter,

2:19

which is located more anteriorly.

PSMA Case: Initial Staging of Prostate Cancer

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Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

This is a 57-year-old male that was diagnosed with a high

0:05

risk prostate adenocarcinoma with a Gleason

0:10

score seven and most recent PSA 20,

0:16

this patient under when an F 18 PSMA that I'm showing, uh,

0:19

here in the case we identify large volume

0:24

of disease in the right side of the prostate

0:28

that is predominantly in the posterior aspect

0:30

of the prostate, but also extends

0:33

beyond the expected location of the peripheral zone.

0:37

There is a question of extension,

0:40

more anteriorly in the center of the prostate

0:43

and also is likely on the left, as well as a focus

0:47

of uptake at the base of the left semial vesicle on these,

0:52

uh, baseline PSMA pet, the patient didn't have any

0:56

nodal disease in the pelvis or elsewhere,

0:59

and there was no evidence of, uh, disease

1:02

outside of the pelvis.

1:04

So he underwent prostatectomy.

1:07

His PSA decreased, but it never completely declined.

1:12

The lowest PSA for him was zero point 24,

1:17

and subsequently it started to rise again

1:21

with the most recent one being 0.9.

1:24

So he underwent a second PSMA

1:28

for restaging to identify where the disease was present.

1:33

And as you can see, we have

1:36

no abnormal uptake at the surgical side,

1:39

but there is a focus of

1:42

mild PSMA uptake in the right pelvic that corresponded

1:47

to a small lymph node.

1:49

Mm-Hmm. And that's the internal iliac territory? Mm-Hmm.

1:53

So this was the only site where there was, uh,

1:57

still p sm a AVID disease.

1:59

And this was a thought to represent the disease

2:04

that was driving the PSA levels.

2:07

Taking a closer look, we can see

2:09

that these actually corresponds to a lymph node

2:12

as I scroll up and down.

2:14

Um, it doesn't track

2:16

and it doesn't correspond to the ureter,

2:19

which is located more anteriorly.

Report

Faculty

Elisa Franquet Elia, MD

Assistant Professor of Radiology

UMass Chan Medical School

Lesson

Introduction to PET/CT Imaging

Lesson

FDG Use in PET/CT

Lesson

FDG: Common Pitfalls and Benign Lesions

Lesson

FDG Use in Hematologic Malignancies

Lesson

FDG Use in Lung Cancer

Lesson

FDG Use in Head & Neck Cancer

Lesson

FDG Use in Breast Cancer

Lesson

FDG Use in Immunotherapy

Lesson

DOTATATE Use in PET/CT

Lesson

DOTATATE and FDG Use in Neuroendocrine Tumors

Lesson

PSMA Use in PET/CT

Lesson

PSMA Use in Prostate Cancer

PSMA Case: Initial Staging of Prostate Cancer