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      PSMA-targeted [ 18F]DCFPyL PET/CT-avid lesions in a patient with prostate cancer: Clinical decision-making informed by the PSMA-RADS interpretive framework

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          Abstract

          We present the case of a man with oligometastatic prostate cancer who underwent a PSMA-targeted 18F-DCFPyL PET/CT scan in order to illustrate how the PSMA-RADS grading sytem can be successfully used to support clinical decision-making and treatment planning. Notably, the presented patient was found to have an equivocal bone lesion (PSMA-RADS-3B) which was further worked up with a tumor protocol MRI and found to be definitively benign (PSMA-RADS-1B) and thus removed from the oligometastatic treatment plan. Remaining avid lesions were incorporated into the treatment plan or deferred for later work-up or monitoring, as indicated within the PSMA-RADS framework.

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          The biology and treatment of oligometastatic cancer

          Diane K. Reyes, Kenneth Pienta (2015)
          Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, were noted on occasion historically and are now termed oligometastasis. The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e. if the primary cancer site (if still present) is controlled, or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be achieved. Contemporary molecular diagnostics are edging closer to being able to determine where an individual metastatic deposit is within the continuum of malignancy. Preclinical models are on the outset of laying the groundwork for understanding the oligometastatic state. Meanwhile, in the clinic, patients are increasingly being designated as having oligometastatic disease and being treated owing to improved diagnostic imaging, novel treatment options with the potential to provide either direct or bridging therapy, and progressively broad definitions of oligometastasis.
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            Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging.

            Ali Afshar-Oromieh, Sara Sheikhbahaei, Kenneth Pienta … (2017)
            The rapidly expanding clinical adaptation of prostate-specific membrane antigen (PSMA)-targeted PET imaging in the evaluation of patients with prostate cancer has placed an increasing onus on understanding both the potential pearls of interpretation as well as limitations of this new technique. As with any new molecular imaging modality, accurate characterization of abnormalities on PSMA-targeted PET imaging can be accomplished only if one is aware of the normal distribution pattern, physiological variants of radiotracer uptake, and potential sources of false-positive and false-negative imaging findings. In recent years, a growing number of reports have come to light describing incidental non-prostatic benign or malignant pathologies with high uptake on PSMA-targeted PET imaging. In this review, we have summarized the published literature regarding the potential pearls and technical and interpretive pitfalls of this imaging modality. Knowledge of these limitations can increase the confidence of interpreting physicians and thus improve patient care.
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              Proposal for a Structured Reporting System for Prostate-Specific Membrane Antigen-Targeted PET Imaging: PSMA-RADS Version 1.0.

              Steven Rowe, Kenneth Pienta, Martin Pomper … (2018)
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                Author and article information

                Contributors
                Steven P. Rowe
                Journal
                Journal ID (nlm-ta): Urol Case Rep
                Journal ID (iso-abbrev): Urol Case Rep
                Title: Urology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2214-4420
                Publication date PMC-release: 09 January 2019
                Publication date Collection: March 2019
                Publication date (Electronic): 09 January 2019
                Volume: 23
                Pages: 72-74
                Affiliations
                [a ]The James Buchanan Brady Urologic Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
                [b ]The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
                [c ]Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
                Author notes
                [∗ ]Corresponding author. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA. srowe8@ 123456jhmi.edu
                Article
                Publisher ID: S2214-4420(18)30357-7
                DOI: 10.1016/j.eucr.2019.01.007
                PMC ID: 6348696
                SO-VID: 75d79ff4-7093-4408-a485-582c22ac718e
                Copyright © © 2019 Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 19 October 2018
                Date revision received : 7 January 2019
                Date accepted : 8 January 2019
                Categories
                Subject: Oncology

                Keywords: psma,dcfpyl,prostate cancer,oligometastatic
                Data availability:
                Keywords: psma, dcfpyl, prostate cancer, oligometastatic

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