Mondia MWL, Batchala PP, Dreicer R, Devitt ME, McCord MR, Mut M, Sheehan JP, Schiff D, Fadul CE. Incidental Brain Metastases From Prostate Cancer Diagnosed With PSMA PET/CT and MRI: A Case Series and Literature Review.
Prostate 2025;
85:841-849. [PMID:
40079497 PMCID:
PMC12068031 DOI:
10.1002/pros.24890]
[Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 02/21/2025] [Accepted: 03/04/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND
Brain metastases (BMETS) from prostate cancer are rare. Hence, brain imaging in neurologically asymptomatic patients with advanced prostate cancer (aPC) is not routinely performed. Prostate-specific membrane antigen (PSMA) PET/CT uses a radiotracer that binds to prostate cancer epithelial cells and is FDA-approved for initial staging for high-risk prostate cancer, detecting prostate cancer recurrence, and determining eligibility for radionuclide therapy.
METHODS
We report six patients with asymptomatic BMETS from aPC found on staging PSMA PET/CT or MRI. Along with cranial MRI, PSMA PET/CT may be useful for detecting asymptomatic intracranial metastasis in select patients with prostate cancer.
RESULTS
Brain metastases were diagnosed in four patients by staging PSMA PET/CT scan-three after systemic disease progression and one during routine surveillance. In two other patients, BMETS were detected using MRI despite negative PSMA PET/CT for brain lesions. All were neurologically asymptomatic. Three patients had undetectable serum prostate-specific antigen (PSA) concentrations; one had neuroendocrine differentiation on histology.
CONCLUSION
In patients with poorly differentiated or neuroendocrine aPC, BMETS may occur without neurologic symptoms and stable PSA. PSMA PET/CT may complement brain MRI for identifying BMETS in these patients.
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