Radium therapy in mCRPC was associated with an increase in PSA in the majority of these heavily pretreated patients. The development of visceral disease was not uncommon, suggesting a need for follow-up computed tomography monitoring during radium-223 therapy. The significance of early increases in PSA and pain with radium-223 is still uncertain. Although pain and PSA flare have been reported in patients who subsequently have a dramatic response to therapy, we observed that a PSA increase or pain flare correlates to an improvement in bone scans only in a minority of patients.
We describe a case with prolonged survival of 2 years in a female patient with pancreatic ductal adenocarcinoma who, at diagnosis, already had liver spread and eventually succumbed to brain metastases which scanned positive with [(111)In-DTPA] octreotide scintiscan (OctreoScan). Subsequently, the patient underwent a craniotomy for resection of the metastases, but her condition deteriorated. A chromogranin A stain was negative, showing that there was no neuroendocrinal component to the cerebral secondaries. In contrast, tumor labeling with a monoclonal antibody associated with a favorable prognosis in pancreatic neoplasms was positive. There is mounting evidence that somatostatin receptor status confers a relatively favorable prognosis in pancreatic adenocarcinoma, although OctreoScan-positive brain metastases have not been previously reported.
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