Prostate cancer recurrence in vas deferens – fusion image guide as an important tool in dignosis

Abstract

The biochemical recurrence after local treatment for prostate cancer is an often challenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites.An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA-68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence.The fusion image technique combines the real–time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously.High resolution acquired in PET / MR associated with image fusion allows orientation procedures, even in areas of difficult access, with greater accuracy than conventional techniques.

Vas Deferens and Inguinal Canal Metastasis of Prostate Cancer Revealed by 68Ga-Prostate-Specific Membrane Antigen PET/CT

“…There are only few prostate cancer cases with vas deferens invasion and/or tumor deposit in the inguinal canal in current literature; some of them were defined by PET/CT with PSMA expression. [3][4][5][6][7][8] Inguinal canal metastasis probably spreads via the lymphatic route, classified as M1a, indicating a poor prognosis. 3 Metastasis to vas deferens may occur directly over the seminal vesicle, via the ejaculatory duct or lymphatic/hematogenous route.…”

“…Vas deferens and inguinal canal metastases of prostate cancer are rare conditions, which are overlooked by radiologists, pathologists, and clinicians. There are only few prostate cancer cases with vas deferens invasion and/or tumor deposit in the inguinal canal in current literature; some of them were defined by PET/CT with PSMA expression 3–8 . Inguinal canal metastasis probably spreads via the lymphatic route, classified as M1a, indicating a poor prognosis 3 .…”

Vas deferens metastasis from prostate adenocarcinoma treated with daily-adaptive MR-guided SBRT on 1.5T MR-linac

“…In the literature there are few cases of VD recurrence after RP, and no one reported treatment details. Valle et al [ 8 ] and Priftakis et al [ 9 ] reported a total of three VD recurrence case, detected by PET-MRI or PSMA-PET/CT. During RP, the VD are dissected and transposed caudally to their distal portion or to SV apex.…”

Is a sampling transition zone important to increase the detection of prostate cancer in systematic prostatic biopsies?

“…Novel technologies are emerging to increase the detection of PCa, such as MRI-TRUS fusion targeted biopsy or the prostate-specific membrane antigen (PSMA) with positron emission tomography (PET)-MRI. This method provides a more specific and accurate biopsy (17)(18)(19); however, it is still not feasible for all hospitals. A cost-benefit analysis to advocate for these technologies in all patients may not support such an action (20).…”