Abstract
A biopsy-proven patient with prostate carcinoma aged 70 years was referred to the department of nuclear medicine for radionuclide-based therapy. His prostate-specific antigen levels were >1000 ng/mL, and prostatic magnetic resonance imaging showed an enlarged prostate with a heterogeneous signal and size 3.8x3.7x3.5 cm with few small heterogeneous nodular signals in the transition zone. He was scheduled for 18F prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scan before therapy. 18F PSMA PET/CT revealed PSMA-expressing prostate lesions (maximum standardized uptake value ~10.2) with extension into the urinary bladder along with bilateral supraclavicular, mediastinal, retrocrural, retroperitoneal, and pelvic lymph nodes and sclerotic lesions in the entire axial and appendicular skeleton.
Keywords: Superscan, prostate carcinoma, 18F PSMA PET/CT, 18F prostate-specific membrane antigen
Abstract
Biyopsi ile kanıtlanmış 70 yaşındaki prostat karsinomu olan hasta, radyonüklid bazlı tedavi için nükleer tıp bölümüne yönlendirildi. Prostat spesifik antijen düzeyi >1000 ng/mL idi ve prostat manyetik rezonans görüntülemede heterojen sinyalli, 3,8x3,7x3,5 cm boyutunda, geçiş bölgesinde az sayıda küçük heterojen nodüler sinyal içeren büyümüş prostat görüldü. Tedavi öncesinde kendisine 18F prostat spesifik membran antijen (PSMA) pozitron emisyon tomografisi/bilgisayarlı tomografi (PET/BT) taraması yapılması planlandı. 18F PSMA PET/BT’de mesaneye uzanan PSMA eksprese eden prostat lezyonu (maksimum standartlaştırılmış tutulum değeri ~10,2) ile birlikte iki taraflı supraklaviküler, mediastinal, retrokrural, retroperitoneal ve pelvik lenf nodları ve tüm aksiyal ve apendiküler iskelette sklerotik lezyonlar ortaya çıktı.
Figure 1.
18F prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scan maximum intensity projection image (A) showing generalized increased patchy tracer uptake throughout the skeleton and reduced tracer uptake in salivary and lacrimal glands, spleen, proximal small gut, and kidneys mimicking a metastatic superscan. The corresponding CT scan showed the sclerotic lesion in the visualized axial and appendicular skeleton with increased radiotracer on PET/CT in sagittal (B) and transaxial sections at the level of the thorax and pelvic regions (C), respectively. Superscan of malignancy is a well-known phenomenon on Tc-99m methylene diphosphonate bone scintigraphy. There is increased patchy/diffuse uptake of radiotracer throughout the skeleton with faint/non-visualization of the kidneys (1). Superscans are often seen in benign conditions (including hyperparathyroidism, renal osteodystrophy and Paget’s disease), myeloproliferative disorders (including leukemia lymphoma and Waldenstrom’s disease), and malignancies (like prostate, breast and lung) (2,3). Superscans indicate advanced stages of disease and have poor prognoses (4,5). 18F PSMA PET/CT has significant value in staging (6), detection of biochemically recurrent prostate cancer (7), risk stratification, and evaluation of distant metastases in prostate carcinoma (8).
Footnotes
Ethics
Informed Consent: The authors certify that they have obtained all appropriate patient consent forms.
Authorship Contributions
Surgical and Medical Practices: M.M.S., Concept: M.M.S., Design: S.D., Data Collection or Processing: L.K., P.B.T., Analysis or Interpretation: S.V., Literature Search: S.V., Writing: M.M.S.
Conflict of Interest: No conflicts of interest were declared by the authors.
Financial Disclosure: The authors declare that this study has received no financial support.
References
- 1.Liu Y. Super-superscan on a bone scintigraphy. Clin Nucl Med. 2011;36:227–228. doi: 10.1097/RLU.0b013e318208f503. [DOI] [PubMed] [Google Scholar]
- 2.Buckley O, O’Keeffe S, Geoghegan T, Lyburn ID, Munk PL, Worsley D, Torreggiani WC. 99mTc bone scintigraphy superscans: a review. Nucl Med Commun. 2007;28:521–527. doi: 10.1097/MNM.0b013e3281744440. [DOI] [PubMed] [Google Scholar]
- 3.Chan M, Schembri GP. Combined 18F-FDG PET/CT and 68Ga DOTATATE PET/CT “superscan” in metastatic pancreatic neuroendocrine tumor. Clin Nucl Med. 2017;42:108–109. doi: 10.1097/RLU.0000000000001499. [DOI] [PubMed] [Google Scholar]
- 4.Chakraborty PS, Sharma P, Karunanithi S, Bal C, Kumar R. Metastatic superscan on (99m)Tc-MDP bone scintigraphy in a case of carcinoma colon: Common finding but rare etiology. Indian J Nucl Med. 2014;29:158–159. doi: 10.4103/0972-3919.136569. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Agarwal KK, Tripathi M, Kumar R, Bal C. Metastatic superscan in prostate carcinoma on gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography scan. Indian J Nucl Med. 2016;31:150–151. doi: 10.4103/0972-3919.178330. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Awenat S, Piccardo A, Carvoeiras P, Signore G, Giovanella L, Prior JO, Treglia G. Diagnostic role of 18F-PSMA-1007 PET/CT in prostate cancer staging: a systematic review. Diagnostics (Basel) 2021;11:552. doi: 10.3390/diagnostics11030552. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Ferrari M, Treglia G. 18F-PSMA-1007 pET in biochemical recurrent prostate cancer: an updated meta-analysis. Contrast Media Mol Imaging. 2021;2021:3502389. doi: 10.1155/2021/3502389. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Wang Z, Zheng A, Li Y, Dong W, Liu X, Yuan W, Gao F, Duan X. 18F-PSMA-1007 PET/CT performance on risk stratification discrimination and distant metastases prediction in newly diagnosed prostate cancer. Front Oncol. 2021;11:759053. doi: 10.3389/fonc.2021.759053. [DOI] [PMC free article] [PubMed] [Google Scholar]