Interesting Image

Metachronous Brain Tumor in 177Lu-PSMA Scan in a Patient with Metastatic Castration Resistant Prostate Cancer Mimicking Disease Progression


  • Elahe Pirayesh
  • Mehrdad Tavakoli

Received Date: 28.06.2020 Accepted Date: 05.01.2021 Mol Imaging Radionucl Ther 2023;32(1):54-56 PMID: 36819190

A 66-year old man known case of metastatic castration resistant prostate cancer underwent successful 6 cycles treatment with 177Lu- prostate-specific membrane antigen. On the last post therapy whole body scan a new lesion in the skull was noted, suspected for disease progression. One week later, the patient complained from weakness of left upper extremity and brain magnetic resonance imaging revealed a brain tumor, confirmed as glioblastoma pathologically.

Keywords: PSMA, mCRPC, glioblastoma, prostate cancer


Informed Consent: The patient consent was obtained.

Peer-review: Externally and internally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: E.P., M.T., Concept: E.P., M.T., Design: E.P., M.T., Data Collection or Processing: E.P., M.T., Analysis or Interpretation: E.P., M.T., Literature Search: E.P., M.T., Writing: E.P., M.T.

Conflict of Interest: No conflict of interest was declare by the authors.

Financial Disclosure: The authors declared that this study received no financial support.


  1. Norouzi G, Aghdam RA, Hashemifard H, Pirayesh E. Excellent response to lower dose of 177Lu-PSMA-617 in a metastatic castration-resistant prostate cancer patient with a transplanted kidney. Clin Nucl Med 2019;44:483-484.
  2. Vogt A, Schmid S, Heinimann K, Frick H, Herrmann C, Cerny T, Omlin A. Multiple primary tumours: challenges and approaches, a review. ESMO Open 2017;2:e000172.
  3. Hamza MA, Kamiya-Matsuoka C, Liu D, Yuan Y, Puduvalli VK. Outcome of patients with malignant glioma and synchronous or metachronous non-central nervous system primary neoplasms. J Neurooncol 2016;126:527-533.
  4. Osman MM, Iravani A, Hicks RJ, Hofman MS. Detection of synchronous primary malignancies with 68Ga-labeled prostate-specific membrane antigen PET/CT in patients with prostate cancer: frequency in 764 patients. J Nucl Med 2017;58:1938-1942.
  5. Grace S, Muzaffar R, Veerapong J, Alkaade S, Poddar N, Phillips N, Guzman M, Batanian J, Vogler C, Lai JP. Synchronous quadruple primary neoplasms: glioblastoma, neuroendocrine tumor, schwannoma and sessile serrated adenoma in a patient with history of prostate cancer. Anticancer Res 2015;35:2121-2127.
  6. Neri D, Bicknell R. Tumour vascular targeting. Nat Rev Cancer 2005;5:436-446.
  7. Salas Fragomeni RA, Amir T, Sheikhbahaei S, Harvey SC, Javadi MS, Solnes LB, Kiess AP, Allaf ME, Pomper MG, Gorin MA, Rowe SP. Imaging of nonprostate cancers using PSMA-targeted radiotracers: rationale, current state of the field, and a call to arms. J Nucl Med 2018;59:871-877.