Lawal Ismaheel O, Bilen Mehmet A, Halkar Raghuveer K, Jani Ashesh B, Schuster David M
Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, United States.
Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa.
World J Nucl Med. 2023 Dec 26;22(4):316-320. doi: 10.1055/s-0043-1777697. eCollection 2023 Dec.
Skeletal metastases due to prostate cancer (PCa) are more commonly osteoblastic than osteolytic. In the rarer cases of osteolytic skeletal metastasis of PCa, transition to osteoblastic phenotype occurs following treatment, which indicates successful healing. In this report, we present a case of spontaneous osteolytic to osteoblastic evolution of PCa skeletal metastasis without treatment in a patient with recurrence of PCa. Our patient is a 59-year-old male who had a robotic radical prostatectomy in July 2014 for a T2c adenocarcinoma of the prostate gland (Gleason score = 4 + 3). He had adjuvant pelvic radiotherapy in January 2015 due to prostate-specific antigen (PSA) persistence. PSA began to rise in October 2015. An F-fluciclovine positron emission tomography/computed tomography (PET/CT) scan obtained in June 2017 at a PSA of 0.5 ng/mL was negative. Repeat F-fluciclovine PET/CT of February 2020 at PSA of 3.72 ng/mL showed prostate bed recurrence and a nonavid osteolytic left inferior pubic ramus lesion. 18F radiohybrid prostate-specific membrane antigen ( F-rhPSMA) PET/CT scan of August 2020 performed as part of an ongoing clinical trial confirmed local prostate bed recurrence with a low-grade radiotracer uptake in the osteolytic left inferior pubic ramus bone lesion. Without salvage therapy, F-fluciclovine PET/CT of October 2020 and March 2022 shows progressive sclerosis in the left pubic ramus lesion. An osteolytic to osteoblastic transition of a bone lesion as shown in this patient calls for a rethink in our understanding of untreated PCa skeletal metastasis progression. This case provides novel insight into the understanding of the temporal evolution of skeletal metastasis and calls for further research.
前列腺癌（PCa）导致的骨转移通常以成骨为主，而非溶骨。在PCa罕见的溶骨性骨转移病例中，治疗后会转变为成骨表型，这表明愈合成功。在本报告中，我们介绍了一例PCa骨转移患者未经治疗而自发从溶骨向成骨演变的病例。我们的患者是一名59岁男性，2014年7月因前列腺T2c腺癌（Gleason评分=4+3）接受了机器人辅助根治性前列腺切除术。由于前列腺特异性抗原（PSA）持续存在，他于2015年1月接受了辅助盆腔放疗。PSA于2015年10月开始升高。2017年6月在PSA为0.5 ng/mL时进行的F-氟代脱氧胸苷正电子发射断层扫描/计算机断层扫描（PET/CT）结果为阴性。2020年2月在PSA为3.72 ng/mL时重复进行的F-氟代脱氧胸苷PET/CT显示前列腺床复发以及左侧耻骨下支溶骨性病变无摄取。作为正在进行的一项临床试验的一部分，2020年8月进行的18F放射性杂交前列腺特异性膜抗原（F-rhPSMA）PET/CT扫描证实了前列腺床局部复发，左侧耻骨下支溶骨性骨病变有低级别放射性示踪剂摄取。在未进行挽救治疗的情况下，2020年10月和2022年3月的F-氟代脱氧胸苷PET/CT显示左侧耻骨支病变逐渐硬化。该患者所示的骨病变从溶骨向成骨的转变需要我们重新思考对未经治疗的PCa骨转移进展的理解。本病例为理解骨转移的时间演变提供了新的见解，并呼吁进一步研究。
