MRI for the detection of prostate cancer origin vertebral metastases in the preosteoblastic phase.
This report describes the case of a gentleman aged 59 years presenting with low-back pain, who had underwent radical prostatectomy for prostate cancer 8 years ago. On evaluation, a slightly elevated serum alkaline-phosphatase level prompted a search for bone metastases. Although x-ray radiography and a bone scan were apparently normal, an MRI scan revealed the presence of metastatic marrow infiltration in the lumbar vertebrae. The patient subsequently was initiated on therapy with androgen-deprivation therapy and bisphosphonates, and currently enjoys symptom-free and progression-free survival. The images in this paper intend to impress upon the limitations of bone scan and x-ray radiography with regard to the detection of vertebral marrow infiltration in the absence of cortical bone invasion. In addition, a brief review of the pathophysiology of vertebral metastases arising from prostate cancer is included.
Department of Radiotherapy & Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. swarooptheone@gmail.com
Swaroop
S
Revannasiddaiah
Madhup
M
Rastogi
Pragyat
P
Thakur
Manoj Kumar
MK
Gupta
Ashwani
A
Sood
Chittranjan
C
Sharma
D003937:Diagnosis, Differential; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D051598:Whole Body Imaging