RNA sequencing is the use of high throughput next generation sequencing technology to survey, characterize, and quantify the transcriptome of a genome. RNA sequencing has been used to analyze the pathogenesis of several malignancies such melanoma, lung cancer, and colorectal cancer. RNA sequencing can identify differential expression of genes (DEG’s), mutated genes, fusion genes, and gene isoforms in disease states. RNA sequencing has been used in the investigation of several colorectal diseases such as colorectal cancer, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), and irritable bowel syndrome.

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A 79-year-old man with metastatic prostate cancer underwent radical prostatectomy and bilateral lymph node dissection and received multiple lines of systematic treatment for his biopsy-proven peritoneal carcinomatosis. During the disease course, his prostate-specific antigen rose from 0.1 ng/mL to 0.4 ng/mL in 4 months, and testosterone level was <3 ng/dL. Workup 18 F-DCFPyL PET/CT showed unusual prostate-specific membrane antigen-avid, 1.1-cm subcarinal lymph node and a 0.8-cm peritoneal nodule, which were not hypermetabolic on an 18 F-FDG PET/CT 6 days later. This case illustrated the sensitivity for 18 F-DCFPyL PET/CT in detecting metastatic castration-resistant prostate cancer.