Maruyama Kaoru, Utsunomia Keita, Nakamoto Takahiro, Kawakita Shigenari, Murota Takashi, Tanigawa Noboru
Departments of Radiology, Kansai Medical University, Japan.
Departments of Urology, Kansai Medical University, Japan.
Asia Ocean J Nucl Med Biol. 2018 Winter;6(1):61-67. doi: 10.22038/aojnmb.2017.9896.
A 76-year-old man with symptomatic bone metastases from castration-resistant prostate cancer underwent Radium-223-dichloride (Ra-223) therapy. Before Ra-223 therapy, he had normal peripheral blood cell counts. Ra-223 therapy relieved his shoulder and low back pain. The elevation of the serum prostate-specific antigen (PSA), doubling every month during Ra-223 therapy, suggested a PSA flare or relapse. Some lesions showed decrease and some lesions showed increase on Tc-99m hydroxymethylene diphosphonate bone scintigraphy at two weeks after the third injection of Ra-223 therapy. Ra-223 therapy was discontinued due to thrombocytopenia that was getting worse rapidly. After treatment discontinuation, namely four weeks after the third injection of Ra-223, F-18 fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/CT and a biopsy were performed to evaluate for metastases, and bone marrow metastases were found. Ra-223 was effective for osteoblastic lesions, but not for bone marrow metastases. FDG PET/CT, but not a Tc-99m based bone scan, detected diffuse bone marrow involvement by cancer. This case report is the first to clarify the utility of FDG PET for the detection of bone marrow metastases confirmed by pathological examination in Ra-223 therapy for progressive castration-resistant prostate cancer.
一名76岁患有去势抵抗性前列腺癌并有症状性骨转移的男性接受了二氯化镭-223（Ra-223）治疗。在接受Ra-223治疗前，他的外周血细胞计数正常。Ra-223治疗缓解了他的肩部和下背部疼痛。在Ra-223治疗期间血清前列腺特异性抗原（PSA）每月翻倍升高，提示PSA激增或复发。在第三次注射Ra-223治疗两周后的锝-99m亚甲基二膦酸盐骨闪烁显像中，一些病灶缩小而一些病灶增大。由于血小板减少迅速加重，停止了Ra-223治疗。在停止治疗后，即第三次注射Ra-223四周后，进行了F-18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT及活检以评估转移情况，发现了骨髓转移。Ra-223对成骨性病灶有效，但对骨髓转移无效。FDG PET/CT而非基于锝-99m的骨扫描检测到癌症弥漫性骨髓浸润。本病例报告首次阐明了FDG PET在检测经病理检查证实的骨髓转移方面的效用，该骨髓转移发生在Ra-223治疗进展性去势抵抗性前列腺癌的过程中。
