Identification of incidental brain tumors in prostate cancer patients via PSMA PET/CT Journal Article
| Authors: | McLaughlin, L. A.; Yildirim, O.; Rosenblum, M. K.; Imber, B. S.; Haseltine, J. M.; Zelefsky, M. J.; Schöder, H.; Morris, M. J.; Rafelson, W. M.; Krebs, S.; Moss, N. S. |
| Article Title: | Identification of incidental brain tumors in prostate cancer patients via PSMA PET/CT |
| Abstract: | Purpose: Brain metastases are rare in patients with prostate cancer and portend poor outcome. Prostate-specific membrane antigen positron emission tomography (PSMA PET)/CT scans including the brain have identified incidental tumors. We sought to identify the incidental brain tumor detection rate of PSMA PET/CT performed at initial diagnosis or in the setting of biochemical recurrence. Methods: An institutional database was queried for patients who underwent 68Ga-PSMA-11 or 18F-DCFPyL (18F-piflufolastat) PET/CT imaging at an NCI-designated Comprehensive Cancer Center from 1/2018 to 12/2022. Imaging reports and clinical courses were reviewed to identify brain lesions and describe clinical and pathologic features. Results: Two-thousand seven hundred and sixty-three patients underwent 3363 PSMA PET/CT scans in the absence of neurologic symptoms. Forty-four brain lesions were identified, including 33 PSMA-avid lesions: 10 intraparenchymal metastases (30%), 4 dural-based metastases (12%), 16 meningiomas (48%), 2 pituitary macroadenomas (6%), and 1 epidermal inclusion cyst (3%) (incidences of 0.36, 0.14, 0.58, 0.07, and 0.04%). The mean parenchymal metastasis diameter and mean SUVmax were 1.99 cm (95%CI:1.25–2.73) and 4.49 (95%CI:2.41–6.57), respectively. At the time of parenchymal brain metastasis detection, 57% of patients had no concurrent extracranial disease, 14% had localized prostate disease only, and 29% had extracranial metastases. Seven of 8 patients with parenchymal brain metastases remain alive at a median 8.8 months follow-up. Conclusion: Prostate cancer brain metastases are rare, especially in the absence of widespread metastatic disease. Nevertheless, incidentally detected brain foci of PSMA uptake may represent previously unknown prostate cancer metastases, even in small lesions and in the absence of systemic disease. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. |
| Keywords: | adult; clinical article; controlled study; aged; middle aged; gene mutation; clinical feature; case report; bone metastasis; cancer patient; cancer radiotherapy; cancer staging; positron emission tomography; brain tumor; follow up; brain neoplasms; cancer diagnosis; cancer incidence; edema; pathology; diagnostic imaging; prostate cancer; prostatic neoplasms; prostate specific membrane antigen; prostatectomy; microsatellite instability; prostate tumor; positron-emission tomography; brain metastasis; prostate adenocarcinoma; meningioma; biochemical recurrence; gallium 68; brain damage; epidermoid cyst; procedures; humans; human; male; article; positron emission tomography-computed tomography; positron emission tomography computed tomography; international standard unit; pituitary macroadenoma; 18f-piflufolastat; 68ga-psma-11; psma pet/ct scan; piflufolastat f 18 |
| Journal Title: | Journal of Neuro-Oncology |
| Volume: | 163 |
| Issue: | 2 |
| ISSN: | 0167-594X |
| Publisher: | Springer |
| Date Published: | 2023-06-01 |
| Start Page: | 455 |
| End Page: | 462 |
| Language: | English |
| DOI: | 10.1007/s11060-023-04355-x |
| PUBMED: | 37247180 |
| PROVIDER: | scopus |
| PMCID: | PMC10746351 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Nelson Moss -- Source: Scopus |
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