Late <sup>68</sup>Ga PSMA-positive Pancreatic Metastasis From Renal Cell Carcinoma in a Patient with Metastatic Prostate Cancer: A Mission Impossible
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June 2024

Late 68Ga PSMA-positive Pancreatic Metastasis From Renal Cell Carcinoma in a Patient with Metastatic Prostate Cancer: A Mission Impossible

Mol Imaging Radionucl Ther 2024;33(2):112-114
1. Acibadem City Clinic UMBAL Mladost Hospital Department of Nuclear Medicine, Sofia, Bulgaria
2. Acibadem City Clinic UMBAL Mladost Hospital Department of Medical Oncology, Sofia, Bulgaria
No information available.
No information available
Received Date: 28.08.2023
Accepted Date: 07.12.2023
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Abstract

We present the case of a patient with newly diagnosed high-risk prostate cancer. The patient underwent nephrectomy for renal cell carcinoma (RCC) in 2009. The prostate-specific membrane antigen (PSMA) scan revealed a primary tumor with seminal vessel involvement, PSMA-positive regional lymph nodes, several nodular lung lesions with mild PSMA uptake, PSMA-positive mediastinal lymph nodes, and a PSMA-positive mass in the pancreatic head. Ultrasound-guided biopsy was performed for the pancreatic lesions revealing metastasis from a RCC. Simultaneous treatment for prostate cancer and metastatic RCC was initiated. To separate metastatic sites for both primaries, we attempted to use fluorodeoxyglucose positron emission tomography/computed tomography, which was moderately positive for the pancreatic mass but not for the other locations. RCC is a 68Ga PSMA-positive tumor; the synchronous combination of RCC with prostate cancer can be confusing and requires more complex clinical interpretation.

Keywords: PSMA, FDG, PET/CT, prostate cancer, RCC, pancreatic metastasis

ABSTRACT

We present the case of a patient with newly diagnosed high-risk prostate cancer. The patient underwent nephrectomy for renal cell carcinoma (RCC) in 2009. The prostate-specific membrane antigen (PSMA) scan revealed a primary tumor with seminal vessel involvement, PSMA-positive regional lymph nodes, several nodular lung lesions with mild PSMA uptake, PSMA-positive mediastinal lymph nodes, and a PSMA-positive mass in the pancreatic head. Ultrasound-guided biopsy was performed for the pancreatic lesions revealing metastasis from a RCC. Simultaneous treatment for prostate cancer and metastatic RCC was initiated. To separate metastatic sites for both primaries, we attempted to use fluorodeoxyglucose positron emission tomography/computed tomography, which was moderately positive for the pancreatic mass but not for the other locations. RCC is a 68Ga PSMA-positive tumor; the synchronous combination of RCC with prostate cancer can be confusing and requires more complex clinical interpretation.

Ethics

Informed Consent: The patient has consented to the use of his medical record for scientific purposes.

Authorship Contributions

Surgical and Medical Practices: A.D., P.B., Concept: P.B., Design: P.B., Data Collection or Processing: G.M., N.N., P.B., Analysis or Interpretation: G.M., N.N., M.G.-T., P.B., Literature Search: P.B., Writing: G.M., P.B.

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

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Katsourakis A, Noussios G, Hadjis I, Alatsakis M, Chatzitheoklitos E. Late solitary pancreatic metastasis from renal cell carcinoma: a case report. Case Rep Med 2012;2012:464808.
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Demirci E, Ocak M, Kabasakal L, Decristoforo C, Talat Z, Halaç M, Kanmaz B. (68)Ga-PSMA PET/CT imaging of metastatic clear cell renal cell carcinoma. Eur J Nucl Med Mol Imaging 2014;41:1461-1462.
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Tariq A, Kwok M, Pearce A, Rhee H, Kyle S, Marsh P, Raveenthiran S, Wong D, McBean R, Westera J, Dunglison N, Esler R, Navaratnam A, Yaxley JW, Thomas P, Pattison DA, Roberts MJ. The role of dual tracer PSMA and FDG PET/CT in renal cell carcinoma (RCC) compared to conventional imaging: A multi-institutional case series with intra-individual comparison. Urol Oncol 2022;40:66.e1-66.e9.
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