|Year : 2022 | Volume
| Issue : 1 | Page : 99-100
Incidental detection of asymptomatic brain metastases due to carcinoma prostate in GA-68 PSMA HBED-CC positron emission tomography-computed tomography: Reiterating its superiority in assessing disease status
Harihara Sudhan Nellaiappan1, Vishnukumar Rajaraman1, Dhanapathi Halanaik1, Ramesh Ananthakrrishnan2
1 Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
2 Department of Radiodiagnosis, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
|Date of Submission||26-Jun-2021|
|Date of Decision||15-Jan-2022|
|Date of Acceptance||17-Jan-2022|
|Date of Web Publication||25-Mar-2022|
Dr. Dhanapathi Halanaik
Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Brain metastasis originating in adenocarcinoma of the prostate is rare and can be expected in cases of disseminated bone and soft-tissue disease. Asymptomatic brain metastasis is rare at any point of the disease stage. Ga-68 PSMA positron emission tomography-computed tomography (PET-CT) is one of the useful investigations for assessing the disease status in adenocarcinoma of the prostate. We report a case of asymptomatic brain metastases detected in Ga-68 PSMA PET-CT scan.
Keywords: 68Ga-PSMA, brain metastasis, prostate carcinoma, PSMA-RADS
|How to cite this article:|
Nellaiappan HS, Rajaraman V, Halanaik D, Ananthakrrishnan R. Incidental detection of asymptomatic brain metastases due to carcinoma prostate in GA-68 PSMA HBED-CC positron emission tomography-computed tomography: Reiterating its superiority in assessing disease status. Indian J Nucl Med 2022;37:99-100
|How to cite this URL:|
Nellaiappan HS, Rajaraman V, Halanaik D, Ananthakrrishnan R. Incidental detection of asymptomatic brain metastases due to carcinoma prostate in GA-68 PSMA HBED-CC positron emission tomography-computed tomography: Reiterating its superiority in assessing disease status. Indian J Nucl Med [serial online] 2022 [cited 2022 Aug 18];37:99-100. Available from: https://www.ijnm.in/text.asp?2022/37/1/99/340847
A 59-year-old male patient was diagnosed with adenocarcinoma of the prostate (Gleason's Score-4 + 4) (pT3bN0Mx). Underwent radical prostatectomy and was on monthly injection leuprolide. 1 year after prostatectomy, he was diagnosed with local recurrence. It was treated with salvage radiotherapy to the pelvis. Ga-68 PSMA HBED-CC positron emission tomography-computed tomography (PET/CT) (Ga-68 PSMA PET/CT) [Figure 1] was done for response assessment. Images (a-c) revealed abnormal tracer accumulation in the enhancing ~2.3 cm × 1.5 cm × 2 cm lesion in the right temporal lobe, SUV max-1.51 (Low grade PSMA expression). S. PSA at that time point was 0.4 ng/dl. Magnetic resonance imaging (MRI) brain was done to confirm brain metastasis. T2-weighted coronal section of the brain (d) showed dural-based extra-axial hyperintense lesion in the right temporal region with no significant edema in the adjacent temporal lobe. Postcontrast axial T1-weighted image (e) showed intense contrast enhancement in the lesion with the enhancement of the underlying duramater and few nonenhancing cystic areas within it, suggestive of dural metastasis. The patient did not have any neurological symptoms. The patient did not undergo further histopathological examination.
|Figure 1: Ga-68 PSMA positron emission tomography-computed tomography images (a-c) reveals abnormal tracer accumulation in the enhancing ~2.3 cm × 1.5 cm × 2 cm lesion in the right temporal lobe, SUV max -1.51. T2 Weighted coronal section of brain (d) showing dural based extra axial hyper intense lesion in the right temporal region with no significant edema in the adjacent temporal lobe. Post contrast axial T1 weighted image (e) showing intense contrast enhancement in the lesion with enhancement of the underlying duramater and few nonenhancing cysti|
Click here to view
Isolated brain metastases are rare in carcinoma prostate. They have a high predilection for the leptomeningeal disease owing to the direct connection of the prostatic venous plexus with Barton's venous plexus. Asymptomatic brain metastases are relatively uncommon and have been reported in only very few instances., Asymptomatic brain metastases with normal S. PSA levels are a rarity.,,
MR brain is considered as the best investigation for evaluating brain metastases., Ga-68 PSMA agents are proven to have a role in initial staging, response assessment, biochemical recurrence in castration-resistant prostate cancer, and radiotherapy planning.,,, In this case, solitary brain metastasis was found in the setting of normal PSA levels. So it was initially reported as PSMA-RADS 3C lesion. Later, metastasis was confirmed by MR brain. It is devoid of any neurological symptoms. If routine investigations such as bone scan, contrast-enhanced computed tomography thorax, and abdomen and MRI pelvis were only performed in this case, Odds of missing of these brain metastasis would be more. Ga-68 PSMA provides the advantage of whole-body assessment. These cases reiterate the superior role of Ga-PSMA PET/CT in assessing the disease status in the cases of carcinoma prostate.
Financial support and sponsorship
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bhambhvani HP, Greenberg DR, Srinivas S, Hayden Gephart M. Prostate cancer brain metastases: A single-institution experience. World Neurosurg 2020;138:e445-9.
Lynes WL, Bostwick DG, Freiha FS, Stamey TA. Parenchymal brain metastases from adenocarcinoma of prostate. Urology 1986;28:280-7.
Chakraborty PS, Kumar R, Tripathi M, Das CJ, Bal C. Detection of brain metastasis with 68Ga-labeled PSMA ligand PET/CT: A novel radiotracer for imaging of prostate carcinoma. Clin Nucl Med 2015;40:328-9.
Ross MI, Bird N, Mendichovszky IA, Rimmer YL. Neurologically asymptomatic cerebral oligometastatic prostate carcinoma metastasis identified on [Ga] Ga-THP-PSMA PET/CT. EJNMMI Res 2020;10:108.
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.
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.
Pecoraro MF, Marengo N, Senetta R, et al
. PSA negative cerebellar metastasis from prostate cancer: a case report. Eur J Oncol Environ Health. 2015 Dec 20;199–202.
Horská A, Barker PB. Imaging of brain tumors: MR spectroscopy and metabolic imaging. Neuroimaging Clin N Am 2010;20:293-310.
Hatzoglou V, Patel GV, Morris MJ, Curtis K, Zhang Z, Shi W, et al.
Brain metastases from prostate cancer: An 11-year analysis in the MRI era with emphasis on imaging characteristics, incidence, and prognosis. J Neuroimaging 2014;24:161-6.
Pomykala KL, Farolfi A, Hadaschik B, Fendler WP, Herrmann K. Molecular imaging for primary staging of prostate cancer. Semin Nucl Med 2019;49:271-9.
Hofman MS, Iravani A. Gallium-68 prostate-specific membrane antigen PET imaging. PET Clin 2017;12:219-34.
Lenzo NP, Meyrick D, Turner JH. Review of gallium-68 PSMA PET/CT imaging in the management of prostate cancer. Diagnostics (Basel) 2018;8:16.
Elschot M, Selnæs KM, Langørgen S, Johansen H, Bertilsson H, Tandstad T, et al.
Prostate-specific membrane antigen PET/magnetic resonance imaging for the planning of salvage radiotherapy in patients with prostate cancer with biochemical recurrence after radical prostatectomy. PET Clin 2019;14:487-98.
Rowe SP, Pienta KJ, Pomper MG, Gorin MA. PSMA-RADS version 1.0: A step towards standardizing the interpretation and reporting of PSMA-targeted PET imaging studies. Eur Urol 2018;73:485-7.