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b: Immunoperoxidase stain of the same group of cells showing positive reaction with synaptophysin (×40)
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We present a rare variant of prostate carcinoma. The patient is a 45-year-old male with elevated prostate-specific antigen levels at screening. Magnetic resonance imaging revealed hyperenhancing lesions throughout the axial skeleton. The fluorine-18 fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) scan showed no abnorma...
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Prostate cancer (PCa) is one of the major causes of death due to cancer in men. Conventional imaging modalities such as magnetic resonance imaging (MRI) provide locoregional status, but fall short in identifying distant metastasis. C-11 choline F-18 fluorocholine (F-18 FCH) has been shown to be useful in imaging of PCa. The present prospective stud...
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... 9 Thus, planar bone scanning is the current standard of care for the evaluation of skeletal metastases, despite its well-recognized limitations. 10 To determine if planar 99m Tc-PSMA imaging successfully provides improved staging over planar technetium-99m labeled -methyl-diphosphonate ( 99m Tc-MDP) bone scans, we compared both scans in five cases of prostate cancer with different risk stratifications. ...
Objective Technetium [Tc99m]-labeled prostate-specific membrane antigen (PSMA) single-photon emission computed tomography/computed tomography (SPECT/CT) is a suitable alternative to prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging. However, the availability of SPECT/CT in many developing countries is limited.
Materials and Methods To evaluate the utility of planar [Tc99m]Tc-PSMA in the absence of SPECT/CT, we compared planar [99mTc]Tc-PSMA and routine bone scan imaging in low-, intermediate-, and high-risk prostate cancer in five patients with histologically confirmed prostate cancer who had both scans within a period of less than 4 days. The mean age of patients was 66.8 ± 5.24, and the median prostate-specific antigen level was 175 ng/mL (range: 0–778 ng/mL).
Results Planar [Tc99m]Tc-PSMA scan provided no additional benefit over bone scans in the low-risk prostate cancer cases. In the cases with intermediate-risk prostate cancers, planar [Tc99m]Tc-PSMA indicated complete and partial response to treatment in oligometastatic and widespread metastatic disease, respectively. In one patient with high-risk prostate cancer, planar [Tc99m]Tc-PSMA detected additional skeletal lesions that were not seen on bone scan.
Conclusion In the absence of SPECT/CT, planar [Tc99m]Tc-PSMA was useful for confirming extent of disease in treated intermediate- and high-risk prostate cancer. It showed little value in low-risk prostate cancer, especially when bone scan is normal. It was particularly useful for treatment response assessment in oligometastatic disease, and its utility should be further explored.
... Small cell variant of prostate carcinoma, a less frequent subset of prostate cancer, is for example more prone to generate lytic bone metastases, which may be missed by FCH PET/CT. 9 Thus, a differential diagnosis reasoning with regard to the cold vertebra finding is mandatory. In conclusion, FCH PET/CT is an effective procedure to image prostate cancer patients. ...
The uptake of F-fluorocholine (FCH), a radiopharmaceutical used to study patients with prostate cancer, follow both the phosphorylcholine and acetylcholine synthesis. FCH uptake is not specific of neoplastic cells because phospholipids are a structural constituent of the membrane of all cells. Thus, PET/CT with FCH show several areas of physiologic uptake. The skeleton concentrates only mild amounts of FCH, thus a diffuse faint uptake of the radiopharmaceutical is present at a PET/CT study. Herein we present the case of a patient in which PET/CT evidenced a sharply defined vertebral "cold" area of reduced FCH uptake corresponding to a vertebral hemangioma.
Objective:
Several studies have reported about the performance of C-choline-PET/computed tomography (CT) (choline) in patients with biochemical recurrent (BCR) prostate cancer, but there is a lack of information regarding negative choline in the same clinical setting. Our aim was to retrospectively analyse negative choline in a cohort of BCR-patients with high prostate-specific antigen (PSA).
Methods and results:
We retrospectively analysed all choline-scans performed at two high-volume imaging centres between 2005 and 2018, selecting those of interest according to the following inclusion criteria: (1) proven prostate cancer treated either with radical prostatectomy or primary external beam radiation therapy (EBRT), (2) BCR after radical prostatectomy or EBRT, (3) PSA serum values >20 ng/mL at the time of scan and (4) scan reported as negative for active disease. Overall, among 5792 scans performed for BCR-prostate cancer, 14 matched the inclusion criteria and were classified as follows: 5/14(36%) inaccurate reports, 3/14(21%) questionable underestimation of positive findings, originally described as unclear, 6/14(43%) negatives. Choline showed a high detection rate in BCR-prostate cancer patients with PSA >20 ng/mL.
Conclusions:
Although negative reports can be found in this clinical setting, in our review various disease-relevant findings were identified in more than half of the cases originally reported as negative warranting a double reading in such cases to avoid false-negative reports.
Prostate cancer is one of the most common cancers affecting men. Bone scan is part of the staging modality commonly used to evaluate bone metastasis. A bone scan with diffused increased skeletal tracer uptake relative to soft tissue, combined with faint renal activity is known as a superscan. However, a primary concern are false negatives associated with bone scans, where diffuse metastasis is indistinguishable on superscans. In this study, we performed xSPECT/CT Bone and standard OSEM SPECT/CT reconstruction algorithm in ten prostate cancer patients with high PSA levels, where they initially seem relatively unremarkable on planar images. All patients with extensive bone metastases showed either relatively unremarkable scans or did not demonstrate the true extent of metastatic burden as seen on planar images. Uptake was further confirmed by the correlative diffuse bone lesions on CT images. Our reports also indicated that xSPECT/CT reconstructed images were far superior in delineating focal areas of osteoblastic bone metastasis, when compared with whole body planar images or SPECT/CT images. The extent of metastatic evidence is delineated with excellent clarification by xSPECT/CT images. We propose that whole body xSPECT/CT image reconstruction, or at least SPECT/CT, should be performed in patients with high PSA levels, along with planar imaging, to improve diagnostic accuracy of bone scans in prostate cancer staging.
Introduction:
Neuroendocrine carcinoma of the prostate (NEPC) is a rare entity. We aimed at providing contemporary data on incidence and survival figures of de-novo NEPC.
Materials and methods:
Within the Surveillance, Epidemiology, and End Results (SEER) database, we identified 309 individuals with de-novo NEPC diagnosed between 2004 and 2013. We evaluated age-adjusted incidence rates over the study. Kaplan-Meier analyses assessed overall survival (OS) after stratification according to histologic subtype, metastatic status, and treatment. Cox regression analyses tested the predictors of overall mortality, after adjusting for confounders.
Results:
A total of 309 cases of NEPC were identified from 510,913 cases of prostate cancer. Metastatic disease was identified in 198 (64.1%) cases. The most common histologic subtype (n = 186; 60.2%) was small-cell carcinoma (SCC). The age-adjusted incidence of NEPC significantly increased over the study span. However, this increase only affected SCC (from 0.13/1,000,000 person-years in 2004 to 0.30/1,000,000 person-years in 2013; P = .001). Median survival for NEPC was 10 months. After stratification by metastatic status, no difference was observed according to SCC versus non-SCC. Treatment with radical prostatectomy improved OS only among individuals with non-metastatic disease, whereas radiation therapy did not affect OS rates. In multivariable Cox regression analyses predicting overall mortality, metastatic stage (hazard ratio, 1.52; 95% confidence interval, 1.12-2.06; P < .01) and radical prostatectomy (hazard ratio, 0.38; 95% confidence interval, 0.20-0.74; P < .01) achieved independent predictor status.
Conclusion:
De-novo NEPC is extremely rare and will be encountered in clinical practice by few urologists. Most cases are metastatic at diagnosis. Prognosis is poor regardless of histologic type, especially in metastatic stage.
Objectives:
Prostate carcinoma is a major health problem, and routine imaging shows only modest results in detecting and restaging clinically localized prostate cancer recurrence. Recent studies have shown promise of radiolabeled analogues of choline for positron emission tomography (PET) scans in patients of biochemical recurrence and that sequentially incremental Fluorocholine (FCH) uptake is associated with malignancy, whereas decreasing tracer activity suggests a benign aetiology. However, this pattern of tracer uptake has not been fully validated, and no standardized (18)F-Fluorocholine ((18)F-FCH) scan protocol is in place yet. This study aimed to better define the role of dual-phase (18)F-FCH PET/computed tomography (CT) imaging using retrospective masked reading focusing on detection of locoregional recurrence/metastasis in patients with biochemical failure after definitive local primary treatment.
Methods:
A total of 32 subjects were enrolled during the period 04/2010 to 05/2014 with histologically proven prostate cancer that was treated with curative intent and had biochemical recurrence. Early scans and delayed imaging of the pelvis were graded separately by blinded readers. Final evaluation using the combination of information from dual-phase studies as a "summation scan" was also performed. Maximum standardized uptake value was computed using regions of interest constructed over focal hyperactivity. Calculations were performed using Statistical Product and Service Solutions, Version 20 for Windows. A composite reference consisting of histopathology, correlation with other imaging, or serum prostate specific antigen (PSA) trend with clinical follow-up of at least 6months was used to determine the true disease status of the patient.
Results:
Early-phase pelvis imaging sensitivity and specificity were calculated to be 73.1% and 90.9%, respectively. Late-phase pelvis imaging sensitivity and specificity were 80.8% and 100%, respectively. Summation scan sensitivity and specificity were 76.9% and 100%, respectively. The odds ratio of having recurrent disease with an uptrend of SUVmax on dual-phase imaging was 33.3. The optimal cutoff value of PSA was 1.85ng/mL with 80% sensitivity and 62.5% specificity.
Conclusions:
Single late-phase FCH PET/CT imaging is a reliable scan modality which can detect sites of disease at low levels of PSA which still fulfil the criteria of biochemical recurrence. This will allow clinicians to identify sites for potential biopsy or start locoregional treatment.
To construct a PSA luciferase report plasmid and monitor the growth and metastasis of prostate cancer after emasculation in SCID mice.
PSA promoter sequence and luciferase gene were amplified by PCR and subsequently inserted into pZsGreen1-1 vector to construct pPSA-FL-Luc vector. LNCaP cells that were stably transfected with pPSA-FL-Luc were used to establish a SCID mouse xenograft model. Then, the growth and metastasis of prostate cancer were monitored via living imaging.
We successfully constructed a PSA luciferase plasmid, pPSA-FL-Luc. DHT enhanced luciferase activity in a concentration-dependent manner in 293T cells with pPSA-FL-Luc transfection. Prostate cancer SCID mouse model was established with pPSA-FL-Luc transfected LNCaP cells. In tumor bearing mice with or without emasculation, pPSA-FL-Luc plasmid was applied to monitored tumor growth and metastasis based on bioluminescence imaging.
We construct a pPSA-FL-Luc plasmid, which stably expresses luciferase and can be applied to monitor tumor development in a prostate SCID mouse model.
Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.
Skeletal metastases are very common in prostate cancer and represent the main metastatic site in about 80% of prostate cancer patients, with a significant impact in patients’ prognosis. Early detection of bone metastases is critical in the management of patients with recently diagnosed high-risk prostate cancer: radical treatment is recommended in case of localized disease; systemic therapy should be preferred in patients with distant secondary disease. Bone scintigraphy using radiolabeled bisphosphonates is of great importance in the management of these patients; however, its main drawback is its low overall accuracy, due to the nonspecific uptake in sites of increased bone turnover. Positron-emitting radiopharmaceuticals, such as fluorine-18-fluorodeoxyglucose, choline-derived drugs (fluorine-18-fluorocholine and carbon-11-choline) and sodium fluorine-18-fluoride, are increasingly used in clinical practice to detect metastatic spread, and particularly bone involvement, in patients with prostate cancer, to reinforce or substitute information provided by bone scan. Each radiopharmaceutical has a specific mechanism of uptake; therefore, diagnostic performances may differ from one radiopharmaceutical to another on the same lesions, as demonstrated in the literature, with variable sensitivity, specificity, and overall accuracy values in the same patients. Whether bone scintigraphy can be substituted by these new methods is a matter of debate. However, greater radiobiological burden, higher costs, and the necessity of an in-site cyclotron limit the use of these positron emission tomography methods as first-line investigations in patients with prostate cancer: bone scintigraphy remains the mainstay for the detection of bone metastases in current clinical practice.
