Prostate adenocarcinoma with mucinous features - is it PSMA avid?

Area of Science:

• Oncology
• Nuclear Medicine
• Radiopharmaceuticals

Background:

• Mucinous prostate adenocarcinoma is a rare subtype of prostate cancer (<0.1%).
• Limited data exists on the primary site ⁶⁸ Ga-PSMA-PET characteristics of this rare entity.
• Prostate-specific membrane antigen (PSMA) Positron Emission Tomography (PET) is a key imaging modality in prostate cancer management.

Observation:

• A case report of an 85-year-old male with ISUP grade 4 acinar adenocarcinoma with mucinous features.
• Magnetic Resonance Imaging (MRI) identified a PI-RADS 5 lesion.
• ⁶⁸ Ga-PSMA-PET revealed an intensely avid primary lesion (SUVmax 10.9) in the prostate.

Findings:

• The ⁶⁸ Ga-PSMA-PET findings were concordant with biopsy results.
• The avid lesion encompassed both the PI-RADS 5 lesion and a PI-RADS 1 lesion, presumed to be the mucinous component.
• This suggests ⁶⁸ Ga-PSMA uptake may vary within different histological components of mucinous prostate adenocarcinoma.

Implications:

• This case provides initial insights into the ⁶⁸ Ga-PSMA-PET imaging appearance of primary mucinous prostate adenocarcinoma.
• Understanding PSMA avidity in rare prostate cancer subtypes is crucial for accurate staging and treatment planning.
• Further research is warranted to elucidate the role of ⁶⁸ Ga-PSMA-PET in managing mucinous prostate adenocarcinoma.