Abstract
Biochemical failure after radical treatment for prostate cancer occurs in up to 30% – 50% of cases. Localisation of clinical disease is challenging because clinical symptoms often manifest long after the initial rise in prostate-specific antigen. The detection rates of imaging modalities such as contrasted computed tomography (CT), bone scan, magnetic resonance imaging and choline positron-emission tomography (PET) or CT, are limited. Prostate-specific membrane antigen (PSMA) ligand PET or CT is a novel imaging modality under investigation for various diagnostic and therapeutic indications in the management of prostate cancer. We present a case report illustrating how <sup><span style="font-size: small;">68</span></sup>Gallium-PSMA ligand PET or CT was used to guide management in a patient presenting with biochemical failure after radical prostatectomy.
Highlights
Biochemical failure in prostate cancer is defined as a rise in prostate-specific antigen (PSA) by ≥ 2 ng/mL above nadir after external beam radiotherapy (EBRT) or two consecutive serum levels ≥ 0.2 ng/mL after radical prostatectomy (RP).[1,2]
A 70-year-old man was referred to our uro-oncology multidisciplinary team (MDT) with a 2-year history of worsening lower urinary tract symptoms, hesitancy and interrupted stream
When functional imaging with choline positron-emission tomography (PET) or computed tomography (CT) and Prostate-specific membrane antigen (PSMA) ligand PET or CT was compared following biochemical recurrence, the detection rates were considerably higher for PSMA PET or CT than choline PET or CT even at PSA values of < 0.5 ng/mL (50% vs. 12.5%) and especially at values > 2 ng/mL (86% vs. 57%).[11]
Summary
Biochemical failure in prostate cancer is defined as a rise in prostate-specific antigen (PSA) by ≥ 2 ng/mL above nadir after external beam radiotherapy (EBRT) or two consecutive serum levels ≥ 0.2 ng/mL after radical prostatectomy (RP).[1,2] This is reported to occur in up to 30% – 50% of cases at 10 years.[3]. He was classified as having high-tier intermediate risk prostate cancer with a life expectancy estimated to be ≥ 10 years His nomogram probability of seminal vesicle involvement was 23% as estimated by the updated Partin tables.[5] The patient was offered an RP or an EBRT. He opted for RP with bilateral pelvic lymph node dissection (BPLND). Membrane antigen (PSMA) positron-emission tomography or computed tomography (PET or CT) was performed This confirmed persistent localised disease in the right seminal vesicle with no distant metastases (Figure 1). He was offered salvage EBRT plus ADT
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