Case 45
Presentation:
History: 74 years, Male with history of prostate cancer, and biochemical failure following radical prostatectomy. PSA: 1.2
An F-18-DCFPyL (PSMA) PET-CT scan was conducted. Figure A displays MIP images at two different intensity levels. Figures B and C displays PET-CT fused images.
Figure A displays MIP images at two different intensity levels.
A
B
C
What are the findings on PSMA PET-CT ?
PSMA PET-CT demonstrates PSMA avid lesions in prostate surgical bed (SUVmax 11.8), bilateral inguinal lymph nodes, pancreas (SUVmax 11.1), and liver (some PSMA avid with maximum SUV of 26.9, others not), and proximal diaphysis of left humerus SUVmax 23.3.
Focal PSMA in the prostate bed is compatible with local recurrence.
The liver lesions and proximal humerus seem the most FDG avid lesions, suggesting a different process. PSMA avid pancreatic mass is concerning for synchronous malignancy.
The PET findings were surprising given the slow rate of PSA change and overall low concentration of PSA.
Biopsy of the liver mass showed a well-differentiated neuroendocrine tumor.
A Ga-68 DOTATATE PET-CT was performed for evaluation of metastatic well-differentiated neuroendocrine tumor.