Patterns of dissemination of prostate cancer relapse, presenting the typical sites of disease manifestation and emphasizing the appearance of the increasingly common forms of atypical spread

Nuclear Medicine

Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of Spread

Felipe G. Barbosa , Marcelo A. Queiroz, Rafael F. Nunes, Publio C. C. Viana, José Flávio G. Marin, Giovanni G. Cerri, Carlos A. Buchpiguel

Author Affiliations

• From the Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, CEP 01308-060, São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.A.Q., P.C.C.V., J.F.G.M., G.G.C., C.A.B.).
• Address correspondence to F.G.B. (e-mail: felipegaliza@gmail.com).

Published Online:Jan 8 2019https://doi.org/10.1148/rg.2019180079

• Sections
• Full text
• PDF
• CME

• Tools
• Share

Abstract

This article demonstrates the different patterns of dissemination of prostate cancer relapse, presenting the typical sites of disease manifestation and emphasizing the appearance of the increasingly common forms of atypical spread. The authors also correlate the imaging findings with the treatment approaches and the potential clinical impact.

The introduction of prostate-specific membrane antigen (PSMA) in clinical practice has revolutionized evaluation of biochemical recurrence of prostate cancer after curative-intent treatment. The high expression of this glycoprotein in prostate cancer cells makes PSMA imaging superior to the current conventional staging methods, namely bone scanning and CT. The high capability of PSMA imaging for identifying very small previously undetected lesions has been widely demonstrated in the literature, leading to a rethinking of patient management by oncologists, urologists, and radiation oncologists. The typical and predictable patterns of spread in prostate cancer are still more prevalent, such as spread to pelvic lymph nodes and bone metastasis, but different patterns of disease spread are becoming more commonly recognized with higher reliability because PSMA imaging allows detection of more typical and atypical lesions than conventional imaging. Furthermore, it is important for the reading physician to recognize and understand the typical disease spread and the most prevalent atypical prostate cancer relapses, not only to heighten the relevancy of reports but also to improve imaging consultancy in multispecialty oncologic practice.