FDG PET-CT is generally not suitable for diagnosing prostate cancer because of low glycolysis of the tumor cells. Neuroendocrine differentiation of the prostate cancer is often associated with early visceral metastasis and dismal prognosis, which is resulted from changed metabolic and regulatory pathways.
Case presentation
A case is reported in this paper that FDG PET-CT demonstrates intense uptake of neuroendocrine tumor of the prostate and multiple metastases.
Conclusion
There is high glycolysis and strong FDG-avidity of neuroendocrine tumor of the prostate, which is similar to that of high grade of neuroendocrine tumor in other tissue and organs. In some selected cases of prostate neuroendocrine cancer, whole body FDG PET-CT may be helpful for detection of metastatic disease.
The online version of this article (doi:10.1186/1477-7819-6-64) contains supplementary material, which is available to authorized users.
Competing interests
The author declares that he has no competing interests.
Authors' contributions
YL conceived and designed the study, and prepared the draft and final manuscript.
Background
Positron emission tomography (PET) is a new imaging modality which has been widely used for detection of metastasis in various malignancies. The most used radiotracer, F18-fluorodeoxyglucose (FDG) is for evaluation of glycolysis and glucose transporter expression. It is well known that most of malignant tumors display increased glucose metabolism. Unfortunately FDG-PET has not been very helpful in prostate cancer because of low glycolysis of the tumor cells. In addition, physiologic urinary excretion of FDG can interfere with imaging of the pelvis [1‐3].
Neuroendocrine differentiation of the prostate cancer contributes to the progression of the disease and often associated with visceral metastases and dismal prognosis [4, 5]. We herein describe the case of a prostate cancer that had neuroendocrine differentiation and multiple metastatic lesions detected by FDG PET-CT.
Anzeige
Case presentation
A 79 year old male with a history of prostate cancer was treated with external radiation and hormone a few years ago. He recently developed gross hematuria and renal failure. CT scan showed bladder mass, hydronephrosis and small lung nodules, but no liver lesion or retroperitoneal lymphadenopathy was noted. The patient underwent nephrostomies and prostate biopsy.
Immunohistochemical studies of the prostate tissue revealed positive staining of the tumor cells for chromogranin, synaptophysin and neuro-specific enolase. The samples were negative for cytokeratin and PSA. In view of the patient's history of prostate adenocarcinoma, the findings were consistent with a high grade of neuroendocrine differentiation.
The patient's whole body bone scintigraphy was negative. The medical oncologist recommended, the patient was also strongly interested in cystoprostatectomy with ileal conduit followed by chemotherapy. As a final pre-surgical work-up, the patient had FDG PET/CT, which demonstrated tumor invasion and infiltration to the bladder as well as multiple metastastic lesions in the liver, lungs and lymph nodes (Figure 1, 2, 3, 4). Compared to a CT less than two months earlier, PET-CT findings suggested marked progression of prostate tumor and multiple new metastases. Therefore, scheduled surgery was cancelled and the patient was treated with chemotherapy (Topotecan) in a hospice facility.
×
×
×
×
Discussion
Neuroendocrine tumor of the prostate is featured by early visceral rather than bone metastases [6]. In this case, a CT scan two months earlier was negative in the liver and for lymphadenopathy, but FDG PET-CT demonstrated extensive hepatic lesions as well as nodal and lung metastases while bone scan was still negative.
Anzeige
FDG-PET scan has its advantages of metabolic and molecular imaging, therefore early detection of malignant disease. In addition, routine whole body imaging make it best imaging modality for staging and restaging of most of the malignant diseases. In prostate adenocarcinoma, FDG-PET often does not display increased uptake. Liu et al found only 4% sensitivity for detecting primary prostate cancer with FDG-PET [7]. But using continuous bladder irrigation, Oyama et al found an increased sensitivity for detecting the prostate tumor [8]. Patients showing increasing prostate specific antigen (PSA) after definite local therapy for prostate cancer represent a diagnostic dilemma. FDG-PET may identify local recurrence and distant metastases with increasing PSA [9]. In addition, Morris et al reported that using PSA levels, bone scintigraphy and soft tissue imaging as references, FDG-PET might be a promising outcome measure after chemotherapy in prostate cancer [10].
With neuroendocrine differentiation, the tumor has different biological behavior [4]. The cells involved in this process secrete a variety of factors that can influence growth patterns and metabolic pathways [11]. This case suggests very high glycolysis and strong FDG-avidity of neuroendocrine tumor of the prostate, which is similar to that of high grade of neuroendocrine tumor in other tissue and organs [12].
To our knowledge, this is the first report of FDG-PET application in neuroendocrine tumor of the prostate and metastatic disease. In some selected cases of neuroendocrine tumor of the prostate, whole body FDG-PET may be helpful for detection of metastasis and therefore change patient's management.
Conclusion
Neuroendocrine tumor of the prostate demonstrates different metabolic characteristics from adenocarcinoma. It has high FDG avidity and often demonstrates early visceral metastases. In some selected cases, FDG-PET may be an ideal imaging modality and helpful for identifying metastatic disease.
Acknowledgements
Written consent was obtained from the patient for publication of this case report.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Competing interests
The author declares that he has no competing interests.
Authors' contributions
YL conceived and designed the study, and prepared the draft and final manuscript.
Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.
Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.
Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.
Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.
Update Chirurgie
Bestellen Sie unseren Fach-Newsletterund bleiben Sie gut informiert.
Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.
Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.