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Case Report: Incidental diagnosis of a PSA-negative prostate cancer by 18FDG PET / CT in a patient with hypopharyngeal cancer

Author(s): J. Bucerius | H. Ahmadzadehfar | E. Habibi | A.Y. Joe | H.J. Biersack

Journal: Iranian Journal of Nuclear Medicine
ISSN 1681-2824

Volume: 14;
Issue: Suppl 1;
Start page: 43;
Date: 2006;
Original page

In 2003, a 63 year old man with a previous diagnosis of hypopharyngeal cancer in 1997, underwent both clinical and biochemical screening for exclusion of PC. Both, serum PSA, with a level within the normal range (1.68 ng/ml) and rectal palpation of the prostate revealed no suspicion of a malignant process of the prostate. As such, no further evaluation was necessary and a 'watchful waiting' strategy was carried out. Two years later, repeated routine screening of the prostate was inconspicuous with a serum PSA level of 2.21 ng/ml and no clinical sign of a mass of the prostate. At the same time, the patient was routinely referred to PET/CT imaging for re-staging of the previously diagnosed hypopharyngeal cancer. PET/CT revealed no suspicious FDG uptake indicating potential metastases of the hypopharyngeal cancer but a small circumscribed uptake within the right-sided pelvis, caudal to the bladder indicating a pathological process within this region. The corresponding CT image failed to show any conspicuousness, but could localize the increased FDG uptake in the right lobe of the prostate. According to this finding, presumed diagnosis of PC was made and the patient underwent biopsy of the prostate followed by radical prostatectomy. At the time of operative resection, PSA level was still within the normal range (1.9 ng/ml). Histology revealed a moderately to poorly differentiated adenocarcinoma of the prostate with TNM stage pT3a, pN0, M0, R0, G 2-3 (according to WHO classification) and a Gleason score of 7.
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