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Case Reports
. 2022 Sep 3;2(5):598-602.
doi: 10.21873/cdp.10148. eCollection 2022 Sep-Oct.

Oligometastatic Lymph Node Recurrence Detected Using 18F-PSMA-1007 PET/CT in a Patient With Castration-resistant Prostate Cancer After Radiation Therapy

Shunsuke Mori  1 , Taigo Kato  1 , Tadashi Watabe  2 , Koji Hatano  1 , Toyohumi Abe  1 , Shinichiro Fukuhara  1 , Hiroshi Kiuchi  1 , Ryoichi Imamura  1 , Motohide Uemura  1 , Norio Nonomura  1
Affiliations
Case Reports

Oligometastatic Lymph Node Recurrence Detected Using 18F-PSMA-1007 PET/CT in a Patient With Castration-resistant Prostate Cancer After Radiation Therapy

Shunsuke Mori et al. Cancer Diagn Progn. .

Abstract

Background/aim: Prostate cancer (PC) is one of the most common types of cancer in men worldwide. Most patients with metastatic PC are treated with androgen deprivation therapy (ADT) using luteinizing hormone-releasing hormone agonists and antagonists as first-line therapy. The majority of PC patients develop a castration-resistant PC (CRPC), which eventually leads to high mortality with poor prognosis, despite new targeted therapies. However, given that oligometastatic recurrence may enable local therapy in CRPC, accurate detection of metastatic lesions may improve clinical outcomes in patients with CRPC.

Case report: We report the case of an 83-year-old man with CRPC. 18Fluorine-prostate-specific membrane antigen-1007 positron emission tomography/ computed tomography (18F-PSMA-1007 PET/CT) revealed weak physiological PSMA accumulation in the prostate and strong accumulation not only in the internal iliac lymph node but also in the two obturator lymph nodes that could not be detected with conventional CT or magnetic resonance imaging. Prostatic re-biopsy revealed no prostate malignancy. Under the diagnosis of oligometastases in the pelvic lymph nodes, the patient underwent laparoscopic pelvic lymph node dissection, which revealed lymph node metastases in two obturator lymph nodes and the internal iliac lymph node, corresponding to the PSMA accumulation sites. The patient experienced at least 7 months of recurrence-free duration without additional treatment.

Conclusion: This study indicates a novel approach to oligometastatic CRPC by means of accurate staging with 18F-PSMA-1007 PET/CT.

Keywords: Prostate cancer; castration-resistant prostate cancer; oligometastatic lymph node recurrence.

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Conflict of interest statement

The Authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1. Imaging tests using conventional computed tomography and magnetic resonance imaging. (A). Abdominal computed tomography examination shows the obturator lymph node with a 15-mm diameter. (B, C) Abdominal magnetic resonance imaging showing signal changes in the obturator lymph node. (B) T2-weighted image, (C) diffusion-weighted image.
Figure 2
Figure 2. Imaging tests using 18Fluorine-prostate-specific membrane antigen (PSMA)-1007-positron emission tomography/computed tomography. (A) 18Fluorine-prostate-specific membrane antigen (PSMA)-1007-positron emission tomography/computed tomography showing weak PSMA accumulation in the prostate and (B) strong accumulation in the two obturator lymph nodes and one internal iliac lymph node.
Figure 3
Figure 3. Histopathological findings after laparoscopic pelvic lymph node dissection. (A) Macroscopic finding of the lymph node within the left obturator fossa. (B) Hematoxylin-eosin staining shows typical lymph node metastasis of prostate cancer cells. Scale bar: 100 μm.
See this image and copyright information in PMC

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