Prostate cancer laparoscopic port site metastasis

Abstract

Introduction:Laparoscopic port site metastases are a rare but clinically important cause of biochemically recurrent prostate adenocarcinoma. C-11 choline, among other prostate-specific positron emission tomography (PET) radiotracers, has improved radiologist confidence in these otherwise difficult-to-detect sites of recurrence.Patient Concerns:A 62-year-old male presented with biochemically recurrent prostate adenocarcinoma after undergoing robotic-assisted radical prostatectomy 5 years earlier.Diagnosis:C-11 choline positron emission tomography/computed tomography (PET/CT) demonstrated a choline-avid soft tissue nodule associated with a laparoscopic port site in the right rectus abdominis muscle, with correlative findings on prior magnetic resonance imaging, and biopsy confirming a prostate adenocarcinoma metastasis.Interventions:The patient was initiated on chemohormonal therapy.Outcomes:His prostate-specific antigen (PSA) became undetectable following chemohormonal therapy. A follow-up C-11 choline PET/CT demonstrated complete resolution of prior abnormal radiotracer activity in the right rectus abdominis muscle.Lessons:Port site metastases in prostate adenocarcinoma are rare; however, those who treat prostate cancer patients should be aware of this phenomenon as the number of minimally invasive oncologic procedures increase. C-11 choline PET, among other prostate-specific PET probes, has become an important tool in evaluating patients with biochemically recurrent prostate adenocarcinoma, identifying site-specific metastases in a majority of patients.

Peritoneal and port site seeding of an undiagnosed urothelial carcinoma of the bladder after robot-assisted laparoscopic prostatectomy

“…A systematic review of port site metastases after robot-assisted surgery revealed histological variance in cases involving surgical device seeding, such as cervical squamous cell carcinoma and adenocarcinomas, gallbladder carcinoma, and urothelial cell carcinoma [11] . Additional primaries associated with port site metastases and seeding events after robot-assisted surgery have been described for renal cell carcinoma, prostate adenocarcinoma, and endometrial carcinoma [4] , [5] , [6] , [7] , [8] , [9] , [13] , [14] .…”

“…Pinho et al reported on a 65-year-old male with Gleason 8 (4+4) prostate adenocarcinoma (pT2c) with positive lateral margin after RALP and elevated postoperative PSA of 0.3 ng/mL 6 weeks postoperatively who underwent adjuvant radiation therapy who developed an elevated PSA associated with a right anterolateral abdominal wall lesion [8] . Lastly, Jundt et al reported on a 62-year-old male with Gleason 7 (4+3) prostate adenocarcinoma (pT2a) who developed PSA recurrence five years after undergoing RALP with 11C-choline PET/CT demonstrating avidity in the soft tissue associated with a prior laparoscopic site [9] .…”

“…Case reports described port site and peritoneal seeding after laparoscopic and/or RALP with prostate adenocarcinoma and an undiagnosed case of pancreatic adenocarcinoma. [4] , [5] , [6] , [7] , [8] , [9] However, we present a case report of an unusual peritoneal and port site seeding by an undiagnosed urothelial carcinoma of the bladder after RALP for localized prostate cancer.…”

Peritoneal and port-site metastasis following robotic-assisted radical prostatectomy

“…3 Only eight previous cases reports were identified to demonstrate peritoneal and portsite metastases following RARP. [4][5][6][7][8][9][10] We present a further four cases of peritoneal and portsite metastases following RARP, adding significantly to the published literature in highlighting this unusual occurrence.…”

Laparoscopic Port-Site Metastasis From Prostate Cancer on 18F-Fluciclovine PET/CT

“…Cases of port-site metastasis from prostatic adenocarcinoma have been described on PET/CT with the use of 11 C-choline, 18 F-FDG, and 68 Ga-prostate-specific membrane antigen. [5][6][7][8][9] This case highlights the advantage of 18 F-fluciclovine PET/CT in evaluating suspected prostate cancer recurrence.…”