Radiographic and metabolic evolution of prostate cancer lung metastasis detected by prostate-specific membrane antigen and fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography

Abstract

We describe the case of a 75-year-old patient who progressed over a 12-year period from localized to symptomatic metastatic prostate cancer (PrCa) with lung as the sole organ of involvement. In this case, the specific sequence of positron emission tomography (PET)-based next-generation imaging with 18 F-sodium fluoride-, 18 F-fluoro-2-deoxy-D-glucose-, and 18 F-DCFPyL PET/computed tomography and biopsies allowed illustration of the pathway of disease progression from nonglycolytic hormone-sensitive PrCa to glycolytic castrate-resistant PrCa without neuroendocrine features. The observations provide a unique insight into the timelines of anatomical and metabolic progression of metastatic PrCa. They highlight the value of close radiographic surveillance of metastatic PrCa with modern imaging to guide early treatment interventions.

Prostate Cancer Lung Metastasis: Clinical Insights and Therapeutic Strategies

“…Specifically, patients with lung metastasis tend to experience a more favorable disease course compared to other sites of visceral metastasis [8]. As in Table 1, prognosis and survival outcomes in prostate cancer lung metastasis vary significantly according to the present studies, with survival ranging from 3 to 88 months and a median survival of 26 months [13,15,17,18,20,21,[23][24][25]28,29,37,39,40,49,51,52,[62][63][64][65][66][67]69,70,[73][74][75]85,86,[91][92][93][94][95][96]. The survival outcomes depend on several factors, including the extent of metastatic spread, the aggressiveness of the disease, the presence of comorbidities, and the effectiveness of treatment interventions [76].…”

“…By curtailing the production of testosterone and other androgens, ADT exerts palliative effects, effectively slowing the advancement of metastatic prostate cancer. This therapeutic strategy remains a cornerstone in the treatment arsenal, contributing significantly to improving patient outcomes [12,15,17,18,20,21,23,25,28,29,39,40,52,[62][63][64][65][66][67][68][69][70][71][72][73][74][75]. Another class which is the ARPIs represent promising therapeutic options in the management of prostate cancer lung metastasis, offering targeted inhibition of the androgen receptor pathway to impede disease progression and alleviate symptoms [29,74].…”

“…This therapeutic strategy remains a cornerstone in the treatment arsenal, contributing significantly to improving patient outcomes [12,15,17,18,20,21,23,25,28,29,39,40,52,[62][63][64][65][66][67][68][69][70][71][72][73][74][75]. Another class which is the ARPIs represent promising therapeutic options in the management of prostate cancer lung metastasis, offering targeted inhibition of the androgen receptor pathway to impede disease progression and alleviate symptoms [29,74]. ARPIs disrupt the signaling cascade essential for prostate cancer cell growth and survival, thereby exerting a profound anti-tumor effect.…”

“…Moreover, emerging evidence supports the efficacy of stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiotherapy (SBRT), in delivering high doses of radiation in a limited number of treatment sessions, thereby providing a convenient and effective treatment option for patients [83][84][85]. By delivering focused radiation to metastatic lesions, several studies showed that radiotherapy can induce tumor regression, improve local control, and complete resolution for patients with prostate cancer lung metastasis [12,15,24,29,41,49,73,87].…”

Prostate Cancer Lung Metastasis: Clinical Insights and Therapeutic Strategies

“…As in Table 1 , most of the patients across all the studies were asymptomatic, while only 13 out of the 58 studies included reported variable clinical symptoms ranging from general symptoms such as hematuria, increased urinary frequency, and weight loss to pulmonary symptoms like cough, dyspnea, chest pain, and hemoptysis [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Several factors contributed to the presenting symptoms, including the number and location of the metastatic lesions.…”