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Prostate-Specific Membrane Antigen-Negative Metastases-A Potential Pitfall in Prostate-Specific Membrane Antigen PET
Clinical Nuclear Medicine
|April 17, 2018
Summary
Prostate cancer metastases can be PSMA-negative, even when PET/CT scans show uptake in the prostate. This case highlights a potential pitfall in interpreting scans for recurrent prostate cancer.
Area of Science:
- Oncology
- Nuclear Medicine
- Pathology
Background:
- Prostate-specific membrane antigen (PSMA) PET/CT is a key imaging modality for recurrent prostate cancer.
- Gallium-68 (Ga)-PSMA-11 PET/CT is widely used for detecting prostate cancer recurrence.
- Accurate staging is crucial for treatment planning in prostate cancer.
Observation:
- A 74-year-old man with biochemical recurrence of prostate cancer post-radiation therapy underwent Ga-PSMA-11 PET/CT.
- PET/CT showed focal uptake in the prostate but no other pathologic uptake.
- CT revealed multiple pulmonary nodules, suspected to be metastases.
Findings:
- Thoracotomy and pathological examination confirmed pulmonary nodules as prostate cancer metastases.
- Immunohistochemical staining revealed a virtual lack of PSMA expression in these metastases.
- This indicates the presence of PSMA-negative prostate cancer metastases.
Implications:
- PSMA-negative metastases represent a significant diagnostic pitfall in PSMA PET/CT interpretation.
- Physicians interpreting PSMA PET/CT scans must be aware of this possibility.
- This finding may impact treatment strategies for patients with advanced prostate cancer.
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