Prostate Cancer - 82 year old male with prostate cancer diagnosed 17 years ago

History
This is an 82 year old male with prostate cancer diagnosed 17 years ago, status post TURP, radiation therapy, orchiectomy in 1995. He has recent rising PSA.

Dosage
11.1mCi F-18 FDG was administered IV per protocol to the left arm.

Procedure
The patient was scanned with the arms up from the level of the eyes down to the proximal femurs approximately 90 minutes post injection per protocol.



PET/CT Findings
PET: There is diffuse irregular increased FDG uptake involving the L3 vertebral body (maximum SUV 6.9). There is focal increased activity also seen in the right side of the lower sacrum (transaxial 269, maximum SUV 4.9) and mild increased uptake in the right SI joint region. No other focal increased activity is seen in the remainder of the spine. There is also focal increased activity in the right proximal femur (maximum SUV 5.3) just inferolateral to the femoral neck. A small focus in the left scapular spine (transaxial 788, maximum SUV 3.3) is very mild. Mild sternal increased activity is likely related to previous sternotomy. There is mild irregular asymmetric increased activity in the left side of the prostate bed (maximum SUV 8.7, although activity is difficult to clearly delineate from adjacent physiologic urinary bladder activity). There is no focal increased activity or asymmetry in the visualized brain or neck. No focal increased activity seen in the lungs, mediastinum, or axillary regions. Right hilar focal activity is mild and non specific. There is no focal increased activity in the liver, adrenal glands, or in the nodal regions of the abdomen and pelvis.

CT scan: Images of the neck, chest, abdomen, and pelvis were acquired with oral contrast and without IV contrast. No adenopathy or skeletal abnormalities are identified in the neck. A calcified granuloma in the right lung base does not have increased FDG uptake. A mostly calcified left lung based 9mm nodule does not have increased FDG uptake. There are a few scattered hepatic cysts in both liver lobes, with additional lesions which are too small to characterize. No adenopathy is identified in the abdomen and pelvis. Diverticulosis is noted throughout the colon. The prostate gland is at least partially removed with no definite abnormalities to correlate with FDG activity. There is partial fusion of the bilateral sacroiliac joints. A subtle abnormality in the right lower sacrum correlates with focal increased FDG uptake. The other skeletal foci of increased FDG uptake do not have a definite abnormality on CT scan.

Impression
1. Mild hypermetabolic left prostatic bed activity is suspicious for recurrent or residual
malignancy.

2. L3, sacral, and right proximal femur focal FDG uptake are suspicious for metastatic
disease. Left scapular spine mild focus is equivocal for malignancy.

Treatment
Chemotherapy

Courtesy of
University of Tennessee Medical Center
David Townsend

NOTE: This PET/CT scan was done as part of a research study, and is not intended for clinical use.