99mTc-HDP Bone Scintigraphy, SPECT/CT, and 18F-FDG PET/CT Diagnosis Imaging of Incidental Pleural Mesothelioma in a Patient With Biochemical Recurrences of Prostate Cancer: Is it Really a Coincidence?

Our plain-English summary of 99mTc-HDP Bone Scintigraphy, SPECT/CT, and 18F-FDG PET/CT Diagnosis Imaging of Incidental Pleural Mesothelioma in a Patient With Biochemical Recurrences of Prostate Cancer: Is it Really a Coincidence?, by P. Fernández-Rodríguez, J.J. Martín-Marcuartu, I. Acevedo Báñez, et al (Clinical Nuclear Medicine, 2020).

The study

• Authors: P. Fernández-Rodríguez, J.J. Martín-Marcuartu, I. Acevedo Báñez, J.M. Masero Carretero, J.M. Jiménez-Hoyuela García
• Journal: Clinical Nuclear Medicine
• Published: 2020;45(3):e148-e150
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We present the case of a 69-year-old man with history of prostate carcinoma treated with prostatectomy and subsequently with external beam radiotherapy and hormone therapy because of biochemical recurrences. More than 10 years after the diagnosis, follow-up Tc-HDP bone scans and SPECT/CT images demonstrated an incidental diagnosis of osteoblastic pleural plaques that quickly evolve to mesothelioma. PET/CT achieved the definitive diagnosis by guiding the biopsy to the highest and most accessible focus of glucidic hypermetabolism. Our case report raises the association between prostate cancer patients treated with external beam radiotherapy and the development of pleural mesothelioma despite having no history of exposure to asbestos.

In plain English

This was a case report, published as a short image article, about one 69-year-old man treated at a hospital in Seville, Spain. He had his prostate removed for prostate cancer in 2007. When the cancer showed biochemical recurrence, he received external beam radiotherapy and hormone therapy. The authors described him as having no history of asbestos exposure. In 2018, a follow-up bone scan unexpectedly showed increased uptake in the upper left chest, which spread over the next 6 months. SPECT/CT showed calcified pleural plaques. A first pleural biopsy found calcified pachypleuritis with reactive mesothelial hyperplasia. An 18F-FDG PET/CT scan was then used to pick the most active spot (SUVmax of 6.45) for a second biopsy. That biopsy gave a final diagnosis of nonresectable epithelioid malignant pleural mesothelioma, and he was treated with pemetrexed. Citing earlier studies, the authors noted a small reported mesothelioma risk linked to radiotherapy for prostate cancer. The authors concluded that their case raises this association and that FDG PET/CT helped plan the biopsy. The report describes one patient, not a rate.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (short 'Interesting Image' article)
• Who was studied: One 69-year-old man with prostate carcinoma treated by prostatectomy in 2007, seen at Virgen del Rocío University Hospital, Seville, Spain
• Exposure: External beam radiotherapy and hormone therapy for biochemical recurrences of prostate cancer. The authors described the patient as having no history of asbestos exposure. No radiation doses were given.
• Main results:
  • Follow-up bone scintigraphy had shown bone metastasis.
  • In 2018 a bone scan showed an incidental linear increase in tracer uptake in the left upper medial chest. Over the following 6 months it spread to occupy the entire left peripheral pulmonary area.
  • SPECT/CT showed the findings to be calcified pleural plaques with extensive hyper-uptake calcifications.
  • A first pleural biopsy by videothoracoscopy showed calcified pachypleuritis with reactive mesothelial hyperplasia, although the scan findings suggested possible mesothelioma.
  • 18F-FDG PET/CT showed the most intense focus in the intercostal space between the third and fourth left anterior ribs, with an SUVmax of 6.45. A second biopsy was taken there.
  • The final diagnosis was nonresectable epithelioid malignant pleural mesothelioma, treated with pemetrexed.
• The authors' conclusion: The authors said their case report raises an association between prostate cancer patients treated with external beam radiotherapy and pleural mesothelioma without asbestos exposure. They also concluded that 18F-FDG PET/CT helps plan image-guided biopsies by locating the most accessible site. The reported radiotherapy-related risk and latency figures come from earlier studies they cited, not from this case.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Carcinoma, Pleural Plaques, Mesothelioma, Biopsy.

Related studies

• Pleural Mesothelioma Detects by 18F-Choline PET/CT in a Patient With Biochemical Recurrence of Prostate Cancer — M. Rensi, G. Ferretti, et al. (2019)
• Peritoneal Deciduoid Malignant Mesothelioma on 67Ga SPECT/CT — Y.C. Lai, Y.C. Wu, et al. (2019)
• Whole-Body MRI: Comparison of Its Capability for TNM Staging of Malignant Pleural Mesothelioma With That of Coregistered PET/MRI, Integrated FDG PET/CT, and Conventional Imaging — Y. Ohno, M. Yui, et al. (2019)
• Present and future roles of FDG-PET/CT imaging in the management of malignant pleural mesothelioma — K. Kitajima, H. Doi, et al. (2016)
• Polymorphisms in oxidative stress-related genes are not associated with prostate cancer risk in heavy smokers — J.Y. Choi, M.L. Neuhouser, et al. (2007)
• Case-control study of risk factors for prostate cancer — M. Ilić, H. Vlajinac, et al. (1996)

Browse more research in Clinical Nuclear Medicine, or return to medical research.