Skip to main content
Top
Published in: EJNMMI Research 1/2020

Open Access 01-12-2020 | Prostate Cancer | Case report

Neurologically asymptomatic cerebral oligometastatic prostate carcinoma metastasis identified on [Ga]Ga-THP-PSMA PET/CT

Authors: M. I. Ross, N. Bird, I. A. Mendichovszky, Y. L. Rimmer

Published in: EJNMMI Research | Issue 1/2020

Login to get access

Abstract

Background

Brain metastases from prostate cancer are rare and usually only occur in the context of widespread systemic disease. This is the first case report of a solitary brain oligometastasis, in a neurologically intact prostate cancer patient with no other systemic disease, detected using [68Ga]Ga-THP-PSMA PET/CT and only the second one using a PSMA-based radiopharmaceutical.

Case presentation

We report the case of a prostate cancer patient presenting 5 years after robot-assisted laparoscopic prostatectomy with biochemical recurrence, no neurological symptoms, and in the absence of metastatic lesions in the body on conventional imaging. A solitary cerebral metastasis was detected using [68Ga]Ga-THP-PSMA PET/CT, surgically resected, leading to a drop in serum PSA and a good recovery.

Conclusion

In this case, [68Ga]Ga-THP-PSMA PET/CT resulted in a major change in clinical management and avoided additional morbidity associated with delayed diagnosis and treatment. This report demonstrates the importance of considering the presence of metastatic disease outside the conventional locations of prostate cancer spread, as well as the importance of ensuring comprehensive [68Ga]Ga-PSMA PET/CT coverage from vertex to upper thighs.
Literature
1.
go back to reference Tremont-Lukats IW, Bobustuc G, Lagos GK, Lolas K, Kyritsis AP, Puduvalli VK. Brain metastasis from prostate carcinoma: The M. D. Anderson Cancer Center experience. Cancer. 2003;98:363–8.CrossRefPubMed Tremont-Lukats IW, Bobustuc G, Lagos GK, Lolas K, Kyritsis AP, Puduvalli VK. Brain metastasis from prostate carcinoma: The M. D. Anderson Cancer Center experience. Cancer. 2003;98:363–8.CrossRefPubMed
2.
go back to reference Guo Y, Mao S, Zhang A, Wang R, Zhang Z, Zhang J, et al. Prognostic significance of young age and non-bone metastasis at diagnosis in patients with metastatic prostate cancer: a SEER population-based data analysis. J Cancer. 2019;10:556–67.CrossRefPubMedPubMedCentral Guo Y, Mao S, Zhang A, Wang R, Zhang Z, Zhang J, et al. Prognostic significance of young age and non-bone metastasis at diagnosis in patients with metastatic prostate cancer: a SEER population-based data analysis. J Cancer. 2019;10:556–67.CrossRefPubMedPubMedCentral
3.
go back to reference Shou J, Zhang Q, Wang S, Zhang D. The prognosis of different distant metastases pattern in prostate cancer: A population based retrospective study. Prostate. 2018;78:491–7.CrossRefPubMed Shou J, Zhang Q, Wang S, Zhang D. The prognosis of different distant metastases pattern in prostate cancer: A population based retrospective study. Prostate. 2018;78:491–7.CrossRefPubMed
4.
go back to reference Gillessen S, Attard G, Beer TM, Beltran H, Bjartell A, Bossi A, et al. Management of patients with advanced prostate cancer: report of the advanced prostate cancer consensus conference 2019. Eur Urol. 2020;77:508–47.CrossRefPubMed Gillessen S, Attard G, Beer TM, Beltran H, Bjartell A, Bossi A, et al. Management of patients with advanced prostate cancer: report of the advanced prostate cancer consensus conference 2019. Eur Urol. 2020;77:508–47.CrossRefPubMed
5.
go back to reference Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, et al. 68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2017;44:1014–24.CrossRefPubMed Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, et al. 68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2017;44:1014–24.CrossRefPubMed
6.
go back to reference Rao KG. Carcinoma of prostate presenting as intracranial tumor with multiple cranial nerve palsies. Urology. 1982;19:433–5.CrossRefPubMed Rao KG. Carcinoma of prostate presenting as intracranial tumor with multiple cranial nerve palsies. Urology. 1982;19:433–5.CrossRefPubMed
7.
go back to reference Lynes WL, Bostwick DG, Freiha FS, Stamey TA. Parenchymal brain metastases from adenocarcinoma of prostate. Urology. 1986;28:280–7.CrossRefPubMed Lynes WL, Bostwick DG, Freiha FS, Stamey TA. Parenchymal brain metastases from adenocarcinoma of prostate. Urology. 1986;28:280–7.CrossRefPubMed
8.
go back to reference Kasabian NG, Previte SR, Kaloustian HD, Ganem EJ. Adenocarcinoma of the prostate presenting initially as an intracerebral tumor. Cancer. 1992;70:2149–51.CrossRefPubMed Kasabian NG, Previte SR, Kaloustian HD, Ganem EJ. Adenocarcinoma of the prostate presenting initially as an intracerebral tumor. Cancer. 1992;70:2149–51.CrossRefPubMed
9.
go back to reference Kunkler RB, Cooksey G, Millac P. Carcinoma of the prostate presenting with a cerebral metastasis. Br J Urol. 1993;71:103–4.CrossRefPubMed Kunkler RB, Cooksey G, Millac P. Carcinoma of the prostate presenting with a cerebral metastasis. Br J Urol. 1993;71:103–4.CrossRefPubMed
10.
go back to reference Gupta A, Baidas S, Cumberlin RK. Brain stem metastasis as the only site of spread in prostate carcinoma. A case report. Cancer. 1994;74:2516–9.CrossRefPubMed Gupta A, Baidas S, Cumberlin RK. Brain stem metastasis as the only site of spread in prostate carcinoma. A case report. Cancer. 1994;74:2516–9.CrossRefPubMed
11.
go back to reference Sutton MA, Watkins HL, Green LK, Kadmon D. Intracranial metastases as the first manifestation of prostate cancer. Urology. 1996;48:789–93.CrossRefPubMed Sutton MA, Watkins HL, Green LK, Kadmon D. Intracranial metastases as the first manifestation of prostate cancer. Urology. 1996;48:789–93.CrossRefPubMed
12.
go back to reference McCutcheon IE, Eng DY, Logothetis CJ. Brain metastasis from prostate carcinoma: antemortem recognition and outcome after treatment. Cancer. 1999;86:2301–11.CrossRefPubMed McCutcheon IE, Eng DY, Logothetis CJ. Brain metastasis from prostate carcinoma: antemortem recognition and outcome after treatment. Cancer. 1999;86:2301–11.CrossRefPubMed
13.
go back to reference Salvati M, Frati A, Russo N, Brogna C, Piccirilli M, D’Andrea G, et al. Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature. J Exp Clin Cancer Res. 2005;24:203–7.PubMed Salvati M, Frati A, Russo N, Brogna C, Piccirilli M, D’Andrea G, et al. Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature. J Exp Clin Cancer Res. 2005;24:203–7.PubMed
14.
go back to reference Sweets T, Bracken RB, Geisler EJ, Warnick R. Intracranial treatment for solitary prostatic adenocarcinoma brain metastasis is curative. Urology. 2009;73:681.e7–9.CrossRef Sweets T, Bracken RB, Geisler EJ, Warnick R. Intracranial treatment for solitary prostatic adenocarcinoma brain metastasis is curative. Urology. 2009;73:681.e7–9.CrossRef
15.
go back to reference Mithal P, Gong Y, Sirkis H, Aronowitz JN. A brain lesion as the sole metastasis of prostate cancer. Journal of Clinical Urology. 2016;9:348–50.CrossRef Mithal P, Gong Y, Sirkis H, Aronowitz JN. A brain lesion as the sole metastasis of prostate cancer. Journal of Clinical Urology. 2016;9:348–50.CrossRef
16.
go back to reference Craig J, Woulfe J, Sinclair J, Malone S. Isolated brain metastases as first site of recurrence in prostate cancer: case report and review of the literature. Curr Oncol. 2015;22:e493–7.CrossRefPubMedPubMedCentral Craig J, Woulfe J, Sinclair J, Malone S. Isolated brain metastases as first site of recurrence in prostate cancer: case report and review of the literature. Curr Oncol. 2015;22:e493–7.CrossRefPubMedPubMedCentral
17.
go back to reference Barakat T, Agarwal A, McDonald R, Ganesh V, Vuong S, Borean M, et al. Solitary brain metastasis from prostate cancer: a case report. Ann Palliat Med. 2016;5:227–32.CrossRefPubMed Barakat T, Agarwal A, McDonald R, Ganesh V, Vuong S, Borean M, et al. Solitary brain metastasis from prostate cancer: a case report. Ann Palliat Med. 2016;5:227–32.CrossRefPubMed
18.
go back to reference Campagna JP, Feia K. Isolated brain metastasis of prostate carcinoma in the setting of normal prostate specific antigen. Urol Case Rep. 2018;21:67–9.CrossRefPubMedPubMedCentral Campagna JP, Feia K. Isolated brain metastasis of prostate carcinoma in the setting of normal prostate specific antigen. Urol Case Rep. 2018;21:67–9.CrossRefPubMedPubMedCentral
19.
go back to reference Yin C, Ho B, Chan L, Emmett L. Asymptomatic prostate cancer brain metastases on 68Ga-PSMA PET/CT. Clin Nucl Med. 2019;44:e382–4.CrossRefPubMed Yin C, Ho B, Chan L, Emmett L. Asymptomatic prostate cancer brain metastases on 68Ga-PSMA PET/CT. Clin Nucl Med. 2019;44:e382–4.CrossRefPubMed
20.
go back to reference Ishizaki F, Maruyama R, Yamana K, Kasahara T, Nishiyama T, Tomita Y. Solitary brain metastasis from prostate cancer after multi modality treatment: A case report. Urol Case Rep. 2019;24:100879.CrossRefPubMedPubMedCentral Ishizaki F, Maruyama R, Yamana K, Kasahara T, Nishiyama T, Tomita Y. Solitary brain metastasis from prostate cancer after multi modality treatment: A case report. Urol Case Rep. 2019;24:100879.CrossRefPubMedPubMedCentral
21.
go back to reference Hafiz A, Karim MU, Qureshi BM, Jabbar AA, Ahmad Z. Solitary brain metastasis: a rare initial presentation of prostate carcinoma. Cureus. 2019;11:e4804.PubMedCentralPubMed Hafiz A, Karim MU, Qureshi BM, Jabbar AA, Ahmad Z. Solitary brain metastasis: a rare initial presentation of prostate carcinoma. Cureus. 2019;11:e4804.PubMedCentralPubMed
22.
go back to reference Derlin T, Schmuck S, Juhl C, Teichert S, Zörgiebel J, Wester HJ, et al. Imaging characteristics and first experience of [68Ga]THP-PSMA, a novel probe for rapid kit-based Ga-68 labeling and PET imaging: comparative analysis with [68Ga]PSMA I&T. Mol Imaging Biol. 2018;20:650–8.CrossRefPubMed Derlin T, Schmuck S, Juhl C, Teichert S, Zörgiebel J, Wester HJ, et al. Imaging characteristics and first experience of [68Ga]THP-PSMA, a novel probe for rapid kit-based Ga-68 labeling and PET imaging: comparative analysis with [68Ga]PSMA I&T. Mol Imaging Biol. 2018;20:650–8.CrossRefPubMed
23.
go back to reference Derlin T, Schmuck S, Juhl C, Zörgiebel J, Schneefeld SM, ACA W, et al. PSA-stratified detection rates for [68Ga]THP-PSMA, a novel probe for rapid kit-based 68Ga-labeling and PET imaging, in patients with biochemical recurrence after primary therapy for prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:913–22.CrossRefPubMed Derlin T, Schmuck S, Juhl C, Zörgiebel J, Schneefeld SM, ACA W, et al. PSA-stratified detection rates for [68Ga]THP-PSMA, a novel probe for rapid kit-based 68Ga-labeling and PET imaging, in patients with biochemical recurrence after primary therapy for prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:913–22.CrossRefPubMed
24.
go back to reference Hofman MS, Eu P, Jackson P, Hong E, Binns D, Iravani A, et al. Cold kit for prostate-specific membrane antigen (PSMA) PET imaging: phase 1 study of 68Ga-Tris(Hydroxypyridinone)-PSMA PET/CT in patients with prostate cancer. J Nucl Med. 2018;59:625–31.CrossRefPubMed Hofman MS, Eu P, Jackson P, Hong E, Binns D, Iravani A, et al. Cold kit for prostate-specific membrane antigen (PSMA) PET imaging: phase 1 study of 68Ga-Tris(Hydroxypyridinone)-PSMA PET/CT in patients with prostate cancer. J Nucl Med. 2018;59:625–31.CrossRefPubMed
25.
go back to reference Young JD, Abbate V, Imberti C, Meszaros LK, Ma MT, Terry SYA, et al. 68Ga-THP-PSMA: a PET imaging agent for prostate cancer offering rapid, room-temperature, 1-step kit-based radiolabeling. J Nucl Med. 2017;58:1270–7.CrossRefPubMed Young JD, Abbate V, Imberti C, Meszaros LK, Ma MT, Terry SYA, et al. 68Ga-THP-PSMA: a PET imaging agent for prostate cancer offering rapid, room-temperature, 1-step kit-based radiolabeling. J Nucl Med. 2017;58:1270–7.CrossRefPubMed
27.
go back to reference Haemels M, Jentjens S, Cleeren F, Sciot R, Lambert J, Van Laere K, et al. All that glitters is not prostate cancer: incidental finding of PSMA-avid meningioma. Hell J Nucl Med. 2020;23:79–80.PubMed Haemels M, Jentjens S, Cleeren F, Sciot R, Lambert J, Van Laere K, et al. All that glitters is not prostate cancer: incidental finding of PSMA-avid meningioma. Hell J Nucl Med. 2020;23:79–80.PubMed
28.
go back to reference Jain TK, Jois AG, Kumar VS, Singh SK, Kumar R, Mittal BR. Incidental detection of tracer avidity in meningioma in 68Ga-PSMA PET/CT during initial staging for prostate cancer. Rev Esp Med Nucl Imagen Mol. 2017;36:133–4.PubMed Jain TK, Jois AG, Kumar VS, Singh SK, Kumar R, Mittal BR. Incidental detection of tracer avidity in meningioma in 68Ga-PSMA PET/CT during initial staging for prostate cancer. Rev Esp Med Nucl Imagen Mol. 2017;36:133–4.PubMed
29.
go back to reference Bilgin R, Ergül N, Çermik TF. Incidental meningioma mimicking metastasis of prostate adenocarcinoma in 68Ga-labeled PSMA ligand PET/CT. Clin Nucl Med. 2016;41:956–8.CrossRefPubMed Bilgin R, Ergül N, Çermik TF. Incidental meningioma mimicking metastasis of prostate adenocarcinoma in 68Ga-labeled PSMA ligand PET/CT. Clin Nucl Med. 2016;41:956–8.CrossRefPubMed
30.
go back to reference Keane F, Ged Y, Greally M, Maher MA, O’Malley K, McCaffrey J. Prostate-specific membrane antigen (PSMA) PET-CT imaging in the investigation and management of biochemical recurrence in prostate cancer. J Clin Oncol. 2018;36(Suppl 6):208.CrossRef Keane F, Ged Y, Greally M, Maher MA, O’Malley K, McCaffrey J. Prostate-specific membrane antigen (PSMA) PET-CT imaging in the investigation and management of biochemical recurrence in prostate cancer. J Clin Oncol. 2018;36(Suppl 6):208.CrossRef
Metadata
Title
Neurologically asymptomatic cerebral oligometastatic prostate carcinoma metastasis identified on [Ga]Ga-THP-PSMA PET/CT
Authors
M. I. Ross
N. Bird
I. A. Mendichovszky
Y. L. Rimmer
Publication date
01-12-2020

Other articles of this Issue 1/2020

EJNMMI Research 1/2020 Go to the issue