Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report

Mremi, Alex; Mbwambo, Orgeness Jasper; Bright, Frank; Mbwambo, Jasper; Mteta, Kien; Ngowi, Bartholomeo Nicholaus

doi:10.1016/j.ijscr.2021.105889

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…Our case reflects this concept, not common but well known among clinicians, displaying a heterogeneous scenario in a single patient with absent PSMA expression in the primary tumour but with high PSMA expression in multiple nodes and bone Pca metastasis. Moreover, although other episodes of uncommon locations for Pca presentation are reported in literature, like Virchow’s node or gingival metastasis ( 10 – 12 ), the peculiarity of this case is represented by the metastatic presentation in whom, interestingly, none of the diagnostic techniques were able to detect the primary tumour within the prostate gland. It is well recognized that several malignancies can present with subdiaphragmatic nodal findings and PSMA is not a purely prostate-specific radiotracer, therefore the presence of multiple PSMA avid lymphadenopathies could have also raised the suspicion of lymphoma; however, the osteoblastic bone lesion was more suggestive of Pca.…”

Section: Discussionmentioning

confidence: 66%

Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge

Vetrone

Cuzzani²,

Mei³

et al. 2023

Front. Oncol.

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This is a case of [68 Ga]Ga-Prostate-specific membrane antigen (PSMA)-11 PET/CT in a 73-years old patient presenting high Prostate Specific Antigen (PSA) levels despite both multi-parametric magnetic resonance imaging (mpMRI) and 12-core saturation biopsy negative for prostate cancer (Pca). This is a highly interesting case because, despite the advanced metastatic spread at initial presentation as showed by [68Ga]Ga-PSMA-PET/CT, the primary Pca was detected by none of the diagnostic techniques (12 random sample biopsy, mpMRI, PSMA PET/CT). However, [68Ga]Ga-PSMA-PET/CT showed a suspicious axillary lesion suitable for biopsy, which finally resulted as Pca metastasis. This case report is therefore a brilliant example of how [68Ga]Ga-PSMA-PET/CT optimized patient’s management.

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Section: Discussionmentioning

confidence: 66%

Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge

Vetrone

Cuzzani²,

Mei³

et al. 2023

Front. Oncol.

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“…The axial skeleton and regional lymph nodes are the most common sites of metastases for prostate cancer,followed by the lungs, bladder, liver and adrenal glands ( 3 ). However, distal metastases to the cervical lymph nodes are very rare, especially as an initial presentation for prostate cancer ( 4 ), the incidence of this condition is less than 0.15% ( 5 ). Besises, the presence of metastatic lymph nodes is a poor prognostic factor in patients with prostate cancer, and the survival rates are significantly reduced in such patients ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Cervical lymphadenopathy as initial presentation of metastatic prostate cancer: A retrospective study of five cases and literature review

et al. 2023

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Cervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. The five patients were treated with hormonal therapy; four received traditional hormonal therapy, including bicalutamide and goserelin; one patient received hormonal therapy that included abiraterone and goserelin. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 3 was still alive at the time of writing. Case 4 was administered with abiraterone, prednisolone and goserelin; the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. Hormone therapy based on abiraterone may yield a better response in such cases.

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Frequency and intensity of [¹⁸F]-PSMA-1007 uptake after COVID-19 vaccination in clinical PET

et al. 2022

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Objectives: To assess the frequency and intensity of [18F]-PSMA-1007 axillary uptake in lymph nodes ipsilateral to COVID-19 vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) in patients with prostate cancer referred for oncological [18F]-PSMA PET/CT or PET/MR imaging. Methods: One hundred twenty six patients undergoing [18F]-PSMA PET/CT or PET/MR imaging were retrospectively included. [18F]-PSMA activity (SUVmax) of ipsilateral axillary lymph nodes was measured and compared with the non-vaccinated contralateral side-and with a non-vaccinated negative control group. [18F]-PSMA active lymph node metastases were measured to serve as quantitative reference. Results: There was a significant difference in SUVmax in ipsilateral and compared to contralateral axillary lymph nodes in the vaccination group (n = 63, p < 0.001) and no such difference in the non-vaccinated control group (n = 63, p = 0.379). Vaccinated patients showed mildly increased axillary lymph node [18F]-PSMA uptake as compared to non-vaccinated patients (p = 0.03). [18F]-PSMA activity of of lymph node metastases was significantly higher (p < 0.001) compared to axillary lymph nodes of vaccinated patients. Conclusions: Our data suggest mildly increased [18F]-PSMA uptake after COVID-19 vaccination in ipsilateral axillary lymph nodes. However, given the significantly higher [18F]-PSMA uptake of prostatic lymph node metastases compared to “reactive” nodes after COVID-19 vaccination, no therapeutic and diagnostic dilemma is to be expected. Advances in knowledge: No specific preparations or precautions (e.g., adaption of vaccination scheduling) need to be undertaken in patients undergoing [18F]-PSMA PET imaging after COVID-19 vaccination.

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Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report

Cited by 4 publications

References 14 publications

Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge

Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge

Cervical lymphadenopathy as initial presentation of metastatic prostate cancer: A retrospective study of five cases and literature review

Frequency and intensity of [¹⁸F]-PSMA-1007 uptake after COVID-19 vaccination in clinical PET

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Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report

Cited by 4 publications

References 14 publications

Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge

Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge

Cervical lymphadenopathy as initial presentation of metastatic prostate cancer: A retrospective study of five cases and literature review

Frequency and intensity of [18F]-PSMA-1007 uptake after COVID-19 vaccination in clinical PET

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Frequency and intensity of [¹⁸F]-PSMA-1007 uptake after COVID-19 vaccination in clinical PET