Peritoneal Carcinomatosis of Prostate Cancer with PSMA-targeted 18F-DCFPyL PET/CT

Abstract

HomeRadiology: Imaging CancerVol. 5, No. 2 PreviousNext Images in CancerFree AccessPeritoneal Carcinomatosis of Prostate Cancer with PSMA-targeted 18F-DCFPyL PET/CTRonald Woodruff , Cameron Henry, Phillip SchererRonald Woodruff , Cameron Henry, Phillip SchererAuthor AffiliationsFrom the Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131 (R.W.); and Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H., P.S.).Address correspondence to R.W. (email: [email protected]).Ronald Woodruff Cameron HenryPhillip SchererPublished Online:Mar 17 2023https://doi.org/10.1148/rycan.220174MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Prostate cancer is the second most common cause of cancer-related death in men. Metastatic spread of prostate cancer frequently involves the bones (84%) and, less commonly, distant lymph nodes (10.6%) and the liver (10.2%) (1). Peritoneal spread of prostate adenocarcinoma is rarely described in the literature, especially without evidence of bony spread or other distant metastatic involvement (2,3). The cause of peritoneal involvement of prostate cancer is poorly understood. While treatment options such as surgical intervention combined with medical therapy have proven effective in preventing local disease recurrence, studies have proposed that laparoscopic prostatectomies may increase the risk of iatrogenic seeding of the peritoneum, causing disease recurrence later in life (4). Cases of peritoneal involvement in the absence of surgical intervention have also been reported, possibly revealing hematogenous or lymphatic spread as a cause. Visceral involvement in prostate cancer is known to be a poor prognostic indicator. Clinicians should consider this diagnosis when performing imaging for patients with a history of prostate adenocarcinoma (Figure).Prostate-specific membrane antigen–targeted fluorine 18 (18F) 2-(3-{1-carboxy-5-[(6-18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (DCFPyL) PET/CT images in an 88-year-old man with a history of prostate adenocarcinoma who presented with worsening fatigue and abdominal distention for over a year. The patient was treated 15 years prior with prostatectomy (Gleason score was 3 + 4 = 7) and continued to receive medical management. Despite treatment, the patient’s prostate-specific antigen level was elevated to 917.61 ng/mL. For restaging, imaging was performed. (A) Coronal PET image shows diffuse intense uptake throughout the peritoneum and omentum. (B, C) Axial PET/CT images show peritoneal nodularity (white arrow), ascites (red arrow), and extensive omental nodularity and stranding (blue arrows), with no evidence of skeletal metastasis. Histologic sample of the mesentery helped confirm prostate adenocarcinoma. No further genetic or histologic testing aided the patient’s diagnosis.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: R.W. No relevant relationships. C.H. Leadership or fiduciary role in Society of Cardiovascular Computed Tomography (SCCT) FiRST committee. P.S. No relevant relationships.Keywords: PET/CT, Prostate, Peritoneum, Omentum, Mesentery, MetastasesAuthors declared no funding for this work.