Prostate carcinoma presenting with diffuse osteolytic metastases and supraclavicular lymphadenopathy mimicking multiple myeloma

Idowu, Bukunmi Michael

doi:10.1002/ccr3.1336

Cited by 18 publications

(13 citation statements)

References 11 publications

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“…[ 3 ] Distant metastasis is common in prostate cancer involving almost all major organs, among them bone is the most common site of distant metastases followed by lung and liver. [ 4 ] At early stage of the disease, nearly 30% of the patients present with skeletal metastases, and this is increased by 90% at later stage of the disease;[ 5 ] because of high incidence of skeletal metastases in prostate cancer, it is important to detect the bone metastases to plan the treatment and assess the prognosis. Whole-body bone scan is sensitive to detect the sclerotic metastases of prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

Determination of the optimal cut-off value of serum prostate-specific antigen in the prediction of skeletal metastases on technetium-99m whole-body bone scan by receiver operating characteristic curve analysis

2020

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Radionuclide whole-body bone scan is a useful investigation of choice to detect the skeletal metastases in prostate cancer. It is indicated in patients having elevated serum prostate-specific antigen (Sr. PSA) or patients with bone pain. Elevated Sr. PSA levels have high predictive value for skeletal metastases; however, there is no consensus regarding cut-off value of Sr. PSA above which bone scan is indicated. This study was performed to find out the accuracy of Sr. PSA test and to know the optimal cut-off value of Sr. PSA with high sensitivity and specificity in the prediction of skeletal metastases on bone scan in prostate cancer patients. A retrospective analysis of medical records of 307 prostate cancer patients referred to the department of nuclear medicine for bone scan between June 2009 and June 2014 was done. Of 307 patients, 15 cases were excluded due to nonavailability of Sr. PSA. Bone scan was performed 3 h after administration of 20 mCi Tc-99m methylene diphosphonate intravenously. Whole-body sweep imaging was performed and spot views were taken wherever required. Of 292 cases, 174 (59.58%) patients had positive bone scan for metastases and 118 (40.41%) patients had negative bone scan for metastases. Maximum and minimum Sr. PSA levels in positive and negative bone scan patients were 1260 and 0.02 ng/ml and 198.34 ng/ml and 0.01 ng/ml, respectively. On comparison of the mean Sr. PSA levels between positive and negative groups, we found significant Sr. PSA levels ( P < 0.05). We used receiver operating characteristic (ROC) curve analyses to find out the accuracy of Sr. PSA test and to know the optimal cut-off value of Sr. PSA with maximum sensitivity and specificity in the prediction of skeletal metastases on bone scan. Area under ROC curve was 0.878 (87%). This indicates that the accuracy of Sr. PSA test in the prediction of skeletal metastases on bone scan was good. The optimal cut-off value of Sr. PSA in the prediction of positive bone scan for skeletal metastases in the management of prostate cancer was 29.16 ng/ml, with sensitivity and specificity of 89.0% and 74.6%, respectively. In this study, we conclude that the accuracy of Sr. PSA test in the prediction of skeletal metastases is good. ROC-derived optimal cut-off value of Sr. PSA for positive skeletal metastases on bone scan is >29.16 ng/ml; thus, the chances of getting positive bone scan for skeletal metastasis are less in prostate cancer patients with Sr. PSA <29.16 ng/ml. ROC-derived sensitivity and specificity of different possible cut-off points of Sr. PSA help reduce the false positive results and increase the diagnostic accuracy of bone scan in the detection of skeletal metastases in prostate cancer patients.

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Section: Introductionmentioning

confidence: 99%

Determination of the optimal cut-off value of serum prostate-specific antigen in the prediction of skeletal metastases on technetium-99m whole-body bone scan by receiver operating characteristic curve analysis

2020

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“…Although in the second patient, there was also lytic lesion of the femur and ramus pubis. Bone metastases cases in prostate cancer with diffuse osteolytic lesions were also reported by Idowu (2018). The signs of spinal cord compression were the main complaints of patients with SRE shown by spinal pain.…”

Section: Discussionmentioning

confidence: 88%

Skeletal-Related Events (SRE) in Prostate Cancer: A Report of Two Cases

Diatmika

Hardjowijoto

2021

FMI

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A skeletal-related event (SRE) is an event occurring due to bone metastasis in prostate cancer. SREs are usually marked by pain, pathological fractures, spinal cord compression, hypercalcemia, or bone metastasis requiring radiotherapy or operation. Case I: A 64-year-old male was diagnosed with a pathological fracture of the left femur. Thoracal CT scan showed osteoblastic lesions in the thoracal vertebrae, sternum, clavicle, and humeral head. Spinal MRI showed destruction of the cervical to sacral vertebral bodies. The histopathological result with Adenocarcinoma Gleason scores 8 (4+4) and an initial prostate-specific antigen (PSA) level of 689,7 ng/dL. Afterward, subcapsular orchiectomy was performed. However, his PSA level was still high (>100 ng/dL) even after serum testosterone had reached a castration level. The patient died during the first chemotherapy using docetaxel. Case II: A 61-year-old male was diagnosed with inferior paraplegia and neurogenic bladder, paraparesis, urinary retention, and pain in the flank area. Spinal MRI showed a pathological compression fracture of the 8th thoracic vertebrae. Thoracal CT scan showed costal and 8th thoracal vertebrae destruction as well as multiple nodules in the lungs. Histological results with Adenocarcinoma Gleason score 9 (4+5) and an initial PSA level of 750 ng/dL. Afterward, subcapsular orchiectomy was performed. Serum testosterone reached castration level with the lowest PSA concentration of 21.6 g/dL. The patient declined chemotherapy and agreed to palliative treatment. He died one year after diagnosis. A high PSA level (>500 ng/dL) could potentially be used as a predictor for severe SRE.

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“…Regardless of subtype, the overwhelming majority of skeletal metastatic disease in prostate cancer is sclerotic in nature, with only isolated cases of osteolytic lesions being mentioned in the literature [6] . The left iliac wing metastasis proved to be challenging to accurately characterize in our case.…”

Section: Discussionmentioning

confidence: 99%

Prostate cancer and sarcoma: Challenges of synchronous malignancies

Wali

Husain

Shah

et al. 2020

Radiology Case Reports

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Synchronous primary malignancies are a rare finding which can be difficult to diagnose. We present the case of a 57-year-old patient with a high prostate specific antigen who was found to have prostate cancer on subsequent magnetic resonance imaging. A skeletal metastasis was also identified at the time, although no osteoblastic activity or sclerosis was identified on skeletal scintigraphy or computed tomography, respectively. The patient was started on hormonal therapy and follow-up imaging revealed the prostate cancer to have reduced in volume. Despite this, the skeletal metastasis appeared unchanged on magnetic resonance imaging and an F18-choline positron emission tomography study was negative. A computed tomography guided bone biopsy was organized and this demonstrated metastatic leiomyosarcoma. As a result, an F18-fluorodeoxyglucose positron emission tomography study was performed to find the primary lesion which demonstrated a large malignant tumor within the calf. Subsequently, the patient was referred to a tertiary sarcoma unit. This case highlights the challenges involved in diagnosing and managing synchronous malignancies.

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Prostate carcinoma presenting with diffuse osteolytic metastases and supraclavicular lymphadenopathy mimicking multiple myeloma

Cited by 18 publications

References 11 publications

Determination of the optimal cut-off value of serum prostate-specific antigen in the prediction of skeletal metastases on technetium-99m whole-body bone scan by receiver operating characteristic curve analysis

Determination of the optimal cut-off value of serum prostate-specific antigen in the prediction of skeletal metastases on technetium-99m whole-body bone scan by receiver operating characteristic curve analysis

Skeletal-Related Events (SRE) in Prostate Cancer: A Report of Two Cases

Prostate cancer and sarcoma: Challenges of synchronous malignancies

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