title: 68Ga-DOTATOC and 68Ga-PSMA PET/CT Unmasked a Case of Prostate Cancer With Neuroendocrine Differentiation.
abstract: A bedridden 90-year-old man with fever and elevated prostate-specific antigen (PSA) (49 ng/mL) was referred for differentiation between infection and tumor. F-FDG PET/CT was negative for infection, but Ga-PSMA PET/CT showed multiple lesions in prostate gland with infiltration to bladder wall and seminal vesicle, consistent with locally advanced prostate cancer. The lesion with the highest Ga-PSMA uptake was strongly avid for Ga-DOTATOC, suggesting neuroendocrine tumor differentiation. After hormonal therapy, PSA normalized, but chromogranin-A increased (from 251 to 398 ng/mL), inferring progression of neuroendocrine tumor differentiation. Advanced prostate cancer may require investigation for pathological neuroendocrine transformation, although PSA may suggest improvement.
authors.affiliation: From the *Department of Nuclear Medicine & PET, Hong Kong Sanatorium & Hospital, Hong Kong; and †Hong Kong Urology Clinic, Hong Kong, China.
authors.forename: Sirong
authors.initials: S
authors.lastname: Chen
authors.forename: Shing Kee
authors.initials: SK
authors.lastname: Cheung
authors.forename: Ka-Nin
authors.initials: KN
authors.lastname: Wong
authors.forename: Kwok Kee
authors.initials: KK
authors.lastname: Wong
authors.forename: Chi-Lai
authors.initials: CL
authors.lastname: Ho
mesh_terms: D000369:Aged, 80 and over; D004492:Edetic Acid / Q000031:analogs & derivatives; D005709:Gallium Isotopes; D005710:Gallium Radioisotopes; D006801:Humans; D008297:Male; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging*; D015282:Octreotide / Q000031:analogs & derivatives*; D009842:Oligopeptides; D009942:Organometallic Compounds; D000072078:Positron Emission Tomography Computed Tomography; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals
chemical_list: C499142:Ga(III)-DOTATOC; D005709:Gallium Isotopes; D005710:Gallium Radioisotopes; D009842:Oligopeptides; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C000718244:gallium 68 PSMA-11; D004492:Edetic Acid; D015282:Octreotide