Solitary castrate-resistant prostate cancer metastasis to adrenal gland with concordant intense avidity on PSMA and FDG PET

Abstract

Isolated prostate cancer metastasis to the adrenal gland is rare. We report a case of concordant high uptake in a solitary adrenal metastasis on both prostate-specific membrane antigen and fluorodeoxyglucose positron-emission tomography in a patient with castrate-resistant prostate cancer. Good initial biochemical response was achieved with laparoscopic adrenalectomy. The patient developed lymph node recurrence 12 months later, although remains asymptomatic on hormonal treatment 22 months post-operatively, in keeping with prior results for metastasis-directed therapy which can delay time to additional treatment. Application of dual tracer PET can be valuable for prostate cancer staging and guidance of metastasis-directed treatment.

Cutaneous, Subcutaneous, and Bilateral Adrenal Gland Metastases in Progressive Prostate Carcinoma: Theranostic Potential of 68Ga-PSMA-11 PET/CT Imaging and 177Lu-PSMA-617 Therapy

“…5 The solitary adrenal metastasis in PC is effectively managed by adrenalectomy as metastasis-directed treatment, but this treatment option is futile in extensive metastatic disease. 6 Here, we report an exceptionally rare case of PC in which 68 Ga-PSMA-11 PET/CT identified unusual metastases in the cutaneous region of the scrotum, penis, and thigh and the subcutaneous region of the anterior abdominal wall, as well as the bilateral adrenal glands. This patient showed progressive disease on standard treatment line and developed castration-resistant state with high PSMA-expressing extensive metastatic disease and was treated with 177 Lu-PSMA-617.…”

“…Therefore, patients die within a year of the onset of cutaneous metastasis in PC 5 . The solitary adrenal metastasis in PC is effectively managed by adrenalectomy as metastasis-directed treatment, but this treatment option is futile in extensive metastatic disease 6 . Here, we report an exceptionally rare case of PC in which 68 Ga-PSMA-11 PET/CT identified unusual metastases in the cutaneous region of the scrotum, penis, and thigh and the subcutaneous region of the anterior abdominal wall, as well as the bilateral adrenal glands.…”

Bilateral Adrenal Metastasis of Prostatic Adenocarcinoma on 68Ga-PSMA PET/CT Imaging

“…False-positive adrenal PSMA uptake has also been reported 9 . Oligometastatic cases have undergone adrenalectomy 10,11 . In this case, systemic treatment was started and regression was observed in all lesions.…”