Prostate-specific membrane antigen avidity on positron emission tomography scan in malignant pleural mesothelioma

Our plain-English summary of Prostate-specific membrane antigen avidity on positron emission tomography scan in malignant pleural mesothelioma, by S.K.D.M. Ekanayake, I.A. Yang, D.B. Godbolt, et al (ANZ Journal of Surgery, 2019).

The study

• Authors: S.K.D.M. Ekanayake, I.A. Yang, D.B. Godbolt, M.N. Windsor, D. Henderson, S. Kyle, D. Sterling, J.C. Lee
• Journal: ANZ Journal of Surgery
• Published: 2019;89(9):E406-E407
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a case report, published as a short 'Images for Surgeons' item by authors from hospitals in Brisbane, Australia. It described a 90-year-old retired man who had never smoked and had worked in agriculture and construction. His only asbestos exposure was minimal, while painting roofs in the 1970s. The article does not name a fiber type. He had prostate cancer that was being monitored without treatment. He came to hospital with breathlessness and a large fluid collection around the left lung. His blood PSA was raised at 36 μg/L (reference less than 6.5). To check whether prostate cancer had spread to the chest, doctors performed a PSMA-PET scan, a scan developed for prostate cancer. It showed mild to moderate uptake in the left pleura, two spots of intense uptake, and uptake in the prostate. Biopsies showed biphasic malignant pleural mesothelioma. The pleural biopsy findings, which included negative PSA staining, were consistent with mesothelioma and excluded spread of prostate cancer as the cause of the chest uptake. The authors called this, to their knowledge, the first reported PSMA-avid mesothelioma. They concluded that PSMA-PET deserved further evaluation as an addition to existing tests.

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 (single patient), published as an 'Images for Surgeons' item; the authors describe it as, to their knowledge, the first reported case of PSMA-avid mesothelioma
• Who was studied: One 90-year-old retired man with untreated, monitored prostate cancer, hypertension, gout and chronic kidney disease, a never-smoker; authors from The Prince Charles Hospital and Royal Brisbane and Womens' Hospital, Brisbane, Australia
• Exposure: Worked in agricultural and construction industries; only minimal asbestos exposure while painting roofs in the 1970s; fiber type not stated
• Main results:
  • The patient's serum prostate-specific antigen (PSA) was elevated at 36 μg/L (reference less than 6.5)
  • Fluid drawn from around the lung showed atypical mesothelial cells and was negative for PSA; the authors describe the cytology as non-diagnostic
  • The PSMA-PET scan showed patchy mild to moderate PSMA avidity mainly in the left pleura
  • The PSMA-PET scan also showed two discrete sites of intense focal avidity, one of them a nodule on the left diaphragmatic crus
  • The PSMA-PET scan showed intense PSMA avidity in the prostate gland; the authors state the prostate cancer was not locally advanced
  • Pleural biopsies obtained by video-assisted thoracoscopy confirmed biphasic type malignant pleural mesothelioma, with features consistent with chest wall invasion
  • PSA staining of the biopsy was negative; the pleural histology as a whole was consistent with mesothelioma and excluded metastatic prostate cancer as the cause of the PSMA avidity in the chest
• The authors' conclusion: The authors concluded that it would be worthwhile to further evaluate PSMA-PET as an addition to existing diagnostic methods (pleural fluid cytology, thoracic CT, FDG-PET and histopathology) for malignant pleural mesothelioma

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.

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