Prostate Cancer Skeletal Metastasis: A Spontaneous Evolution from Osteolytic to Osteoblastic Morphology without Treatment

Ismaheel O Lawal; Mehmet A Bilen; Raghuveer K Halkar; Ashesh B Jani; David M Schuster

doi:10.1055/s-0043-1777697

Prostate Cancer Skeletal Metastasis: A Spontaneous Evolution from Osteolytic to Osteoblastic Morphology without Treatment

World J Nucl Med. 2023 Dec 26;22(4):316-320. doi: 10.1055/s-0043-1777697. eCollection 2023 Dec.

Authors

Ismaheel O Lawal^{1

2}, Mehmet A Bilen³, Raghuveer K Halkar¹, Ashesh B Jani⁴, David M Schuster¹

Affiliations

¹ Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, United States.
² Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa.
³ Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, United States.
⁴ Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, United States.

Abstract

Skeletal metastases due to prostate cancer (PCa) are more commonly osteoblastic than osteolytic. In the rarer cases of osteolytic skeletal metastasis of PCa, transition to osteoblastic phenotype occurs following treatment, which indicates successful healing. In this report, we present a case of spontaneous osteolytic to osteoblastic evolution of PCa skeletal metastasis without treatment in a patient with recurrence of PCa. Our patient is a 59-year-old male who had a robotic radical prostatectomy in July 2014 for a T2c adenocarcinoma of the prostate gland (Gleason score = 4 + 3). He had adjuvant pelvic radiotherapy in January 2015 due to prostate-specific antigen (PSA) persistence. PSA began to rise in October 2015. An ¹⁸ F-fluciclovine positron emission tomography/computed tomography (PET/CT) scan obtained in June 2017 at a PSA of 0.5 ng/mL was negative. Repeat ¹⁸ F-fluciclovine PET/CT of February 2020 at PSA of 3.72 ng/mL showed prostate bed recurrence and a nonavid osteolytic left inferior pubic ramus lesion. 18F radiohybrid prostate-specific membrane antigen ( ¹⁸ F-rhPSMA) PET/CT scan of August 2020 performed as part of an ongoing clinical trial confirmed local prostate bed recurrence with a low-grade radiotracer uptake in the osteolytic left inferior pubic ramus bone lesion. Without salvage therapy, ¹⁸ F-fluciclovine PET/CT of October 2020 and March 2022 shows progressive sclerosis in the left pubic ramus lesion. An osteolytic to osteoblastic transition of a bone lesion as shown in this patient calls for a rethink in our understanding of untreated PCa skeletal metastasis progression. This case provides novel insight into the understanding of the temporal evolution of skeletal metastasis and calls for further research.

Keywords: 18 F-fluciclovine PET/CT; 18 F-rhPSMA PET/CT; biochemical recurrence; prostate cancer; skeletal metastasis progression.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).

Publication types

Case Reports