Case Author(s): Jeff Chesnut, D.O. and Keith Fischer, M.D. , 7/28/99 . Rating: #D3, #Q4

Diagnosis: Metastatic prostate carcinoma

Brief history:

52 year old male with prostate carcinoma.

Images:

Anterior and posterior spot views are shown

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Full history/Diagnosis is available below

Diagnosis: Metastatic prostate carcinoma

Full history:

This patient is a 52 year old male with prostate carcinoma who is pre-decision for definitive therapy. At the time of this study, he was on hormonal therapy only. He has a Gleason 6 tumor with a PSA value of 48ng/ml. A CT scan at an outside hospital (not available) described mildly enlarged nodes in the retroperitoneum at the level of the left renal hilum.

Radiopharmaceutical:

5.4 mCi In-111 capromab pendetide

Findings:

There is the expected activity in the blood pool, liver, bone marrow, and gastrointestinal tract. Abnormal antibody uptake is seen in the left supraclavicular region, the retroperitoneal region at the level of the left renal hilum and inferiorly extending down the right common common iliac lymph node chain. There is also abnormal activity in the prostate area as expected in this patient whose prostate is still in situ. There is abnormal uptake in the left internal iliac nodes.

Discussion:

Capromab pendetide (ProstaScint) is a murine monoclonal antibody directed against prostate specific membrane antigen (PSMA). It reportedly has an affinity for approximately 95% of adenocarcinomas of the prostate. Its primary use is the detection of soft tissue metastases of prostate carcinoma. For the detection of bone metastases, bone scintigraphy is the preferred imaging study of choice.

Normal biodistribution of Capromab Pendetide includes the most intense activity in the liver, spleen, bone marrow, and blood pool. Varying levels of activity are seen in the kidneys, nasopharynx, spermatic cord and genitalia.

"In primary disease, Capromab Pendetide imaging should be reserved for use in patientswith negative bone scans who are at high risk for metastatic disease based on clinical stage, Gleason score, and PSA level. A negative scan does not eliminate the need for a staging lymph node dissection but should encourage further pursuit of local treatment options. A positive scan in this high risk setting would support proceeding with systemic treatment options or watchful waiting." (Haseman and Reed; Nuclear Medicine Annual 1998., ed. Leonard Freeman, M.D.; Lippincott-Raven Publishers, Philadelphia, 1998.)

Major teaching point(s):

1. Capromab Pendetide (ProstaScint) is used for the detection of soft tissue metastases from prostate carcinoma in high risk patients.

2. Capromab Pendetide should not be the primary imaging modality for the detection of metastatic bone lesions.

ACR Codes and Keywords:

References and General Discussion of (Anatomic field:Genitourinary System, Category:Effect of Trauma)

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Case number: pr002

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