Visualization of Intermetastatic Heterogeneity in Mixed Neuroendocrine Carcinoma–Acinar Adenocarcinoma of the Prostate by 68Ga-PSMA, 68Ga-FAPI, and 18F-FDG PET/CT

Abstract

Mixed neuroendocrine carcinoma-acinar carcinoma is an uncommon histological type of neuroendocrine prostate cancer. It has been rarely reported in de novo prostate malignancies. In this case, we present 68 Ga-PSMA (prostate-specific membrane antigen), 68 Ga-FAPI, and 18 F-FDG PET/CT findings in the de novo form of mixed large-cell neuroendocrine carcinoma-acinar adenocarcinoma of the prostate. Different levels of radiotracer uptake were observed in different metastatic sites on 68 Ga-PSMA, 68 Ga-FAPI, and 18 F-FDG PET/CT. This case demonstrates that the multitracer PET/CT strategy may be used for the noninvasive detection of the intermetastatic heterogeneity in metastatic neuroendocrine prostate cancer.

Advancements in PSMA ligand radiolabeling for diagnosis and treatment of prostate cancer: a systematic review

“…Additionally, it may be less sensitive to certain tumor types, such as breast and prostate cancer. In instances where these limitations are notable, alternative PET tracers may prove more suitable for achieving higher specificity and sensitivity in imaging and diagnosis (9)(10)(11)(12). PSMA (Prostate Specific Membrane Antigen) is a membrane antigen characterized by high expression in prostate tissue and on the surface of prostate cancer cells.…”

Small Cell Neuroendocrine Carcinoma of the Prostate on 18F-DCFPyL and 18F-FDG PET/CT

“…Conventional surveillance with PSA levels is challenging as they are often discordant with the volume of disease 2,4 . Furthermore, surveillance with 18 F-DCFPyL or 68 Ga-PSMA-PET may yield false-negative results as described in other cases where scanning with 18 F-FDG or 68 Ga-DOTATATE revealed lesions that were occult on 18 F-DCFPyL or 68 Ga-PSMA-PET 5–7 . The role of 18 F-FDG PET is thought to be particularly helpful in the detection of soft tissue and visceral metastases 8 .…”