Case 1: A 77-year-old male patient with high-risk T3bN0M0 Gleason 4+5 adenocarcinoma, 7 years post radical prostatectomy and salvage radiotherapy and 6 years androgen deprivation therapy presented increased PSA (6.39 ng/mL).
Chest CT demonstrated nodular consolidation, pleural nodules, and fissural nodularity in the right lung.
This pattern was thought to be specific in prostate cancer metastasis, and instead, lung cancer with pleural dissemination was the most suspected. [18F]-FACBC PET/CT was performed to investigate the source of the biochemical recurrence.
It showed multiple foci of increased radiotracer uptake along the right pleura with indicative SUVmax 3.73 and a focal hypermetabolic nodular lesion in the right apical lung (Figure 1).
VATS pleural biopsy confirmed adenocarcinoma with positive PSA and PSA IHC stains.
Case 2: A 72-year-old man with high-risk cT3aN0M0 Gleason 3+4 adenocarcinomas, 1 year post definitive radiotherapy.
The patient presented a high PSA of 42 ng/mL.
Restaging [18F]-FACBC PET/CT image demonstrated tracer avidity within several abdominal lymph nodes (Figure 2).
In contrast, CT only exhibited small-sized lymph nodes of the correlating portion, indicating benign reactive lymph nodes.