Clinical History
The patient is a 67 year old male with known prostate
cancer. The prostate was removed in 1993. His PSA
levels have been doubling approximately every nine
months and his PSA is now 13.2. We have been asked
to examine him for the presence of prostate carcinoma
in the prostate bed as well as look for prostatic pelvic
metastases.
Technique
On 3/14/97 the patient received an intravenous
injection of 5.3 millicuries of Indium 111 Prostascint.
Twenty minutes later SPECT imaging of the pelvis
was carried out. The study is technically satisfactory.
Reconstruction was performed according to current
specifications. Great vessels, marrow uptake and
bladder are identified for comparison with later
studies.
Findings
On 3/18/97 (day 4) a whole body Prostascint scan
was performed. Anterior and posterior whole body
images were obtained. A normal distribution of the
Indium 111 label is identified in liver, heart blood pool,
genitalia and spleen. SPECT imaging of the pelvis
was then carried out. There was no patient motion.
Images were reconstructed in standard fashion.
Transverse, coronal, sagittal images were obtained.
Penile activity is identified in transverse images.
Comparison with the day 0 blood pool images
suggests there is an increased radiotracer
localization in the prostate bed just superior to the
base of the penis and posterior and inferior to the
bladder. Repeat SPECT imaging with static anterior
posterior planar imaging was performed at day 6.
Again noted in the prostate bed is a focal increase in
activity suggesting active disease. In transverse
images 26 and 27 in the floor of the pelvis to the left of
the prostate bed is an asymmetrical region of focal
uptake suggestive of lymph node metastasis.
Impressions
PROBABLE ACTIVE PROSTATIC CANCER IN THE
PROSTATE BED WITH PROBABLE LEFT PELVIC
LYMPH NODE METASTASIS.
Comments
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