Case report: Breast metastasis in a prostate cancer patient

Patient history, diagnosis and therapy

At the age of 63, the patient was first diagnosed with prostate cancer, initial stage pT2a, pN0, cM1, Gleason score 4 + 3 = 7, iPSA 8.8 ng/ml. Staging with magnetic resonance imaging (MRI) of the pelvis indicated extended local tumor including infiltration of the bladder, no suspicious lymph nodes were found. A radical prostatovesiculoectomy was performed. 5 years later, a local recurrence occurred, after which salvage radiotherapy of the prostate bed was carried out. This was followed by another local recurrence 8 years later with bladder floor infiltration, leading to surgical resection of the bladder (cystectomy) and the creation of an ilium conduit for urinary diversion (stage of relapse: pT4, cN0, M1, R1, L0, V0, Gleason 5 + 5 = 10). 3 years later there was an increasingly progressive course with disseminated bone metastases and a recurrent local relapse in the prostate bed. In the same year, irradiation of the bone metastases and taxane-containing chemotherapy (3 cycles Docetaxel) were performed for palliation. Due to subsequent further morphological disease progression, increasing PSA and aggravation of pain, we opted for radionuclide therapy with Lutetium-177-PSMA as compassionate use due to the lack of other therapy options. Before Lutetium-177-PSMA therapy, Gallium-68-PSMA PET/CT was carried out showing intense expression in local recurrence, multiple bone metastases in the whole skeletal system as well as in pelvic and retroperitoneal lymph nodes classified as PSMA-RADS 5 according to [1]. In addition, the PET/CT examination showed intense expression of PSMA in a mass in the left breast ([Fig. 1]). As initially, breast cancer was suspected this lesion was classified as PSMA-RADS 3C. However, a breast biopsy under local anesthesia with histological evaluation did not confirm this suspicion. Surprisingly, the histological examination revealed metastases from prostate cancer in the left breast ([Fig. 2]).

Publication History

Article published online:
18 March 2021

• References

• 1 Rowe S, Pientha KJ, Pomper MG. et al Proposal of a Structured Reporting System for Prostate-Specific Membran Antigen (PSMA)-Targeted PET Imaging: PSMA-RADS Version 1.0. J Nucl Med 2017; 59 (03) 479-485 DOI: 10.2967/jnumed.117.195255.
• 2 Yordanova A, Linden P, Hauser S. et al Outcome and safety of rechallenge [¹⁷⁷Lu] Lu-PSMA-617 in patients with metastatic prostate cancer. Eur J Nucl Med Mol Imaging 2019; 46 (05) 1073-1080 DOI: 10.1007/s00259-018-4222-x.
• 3 Das R, Gregory PA, Fernandes RC. et al MicroRNA-194 Promotes Prostate Cancer Metastasis by Inhibiting SOCS2. Cancer Res 2017; 77 (04) 1021-1034 DOI: 10.1158/0008-5472.CAN-16-2529.
• 4 Tolkach Y, Gevensleben H, Bundschuh R. et al Prostate-specific membrane antigen in breast cancer: a comprehensive evaluation of expression and a case report of radionuclide therapy. Breast Cancer Res Treat 2018; 169: 447-455
• 5 Spatz S, Tolkach Y, Jung K. et al. Comprehensive Evaluation of Prostate-Specific Membran Antigen Expression in the Vasculature of Renal Tumors: Implication for Imaging Studies and Prognostic Role. J Urol 2018; 199 (02) 370-377
• 6 Tolkach Y, Goltz D, Kremer A. et al Prostate-specific membrane antigen expression in hepatocellular carcinoma: potential use for prognosis and diagnostic imaging. Oncotarget 2019; 10 (41) 4149-4160 . Published 2019 Jun 25. DOI: 10.18632/oncotarget.27024.
• 7 Shetty D, Loh H, Bui C. et al Elevated 68Ga Prostate-Specific Membrane Antigen Activity in Metastatic Non-Small Cell Lung Cancer. Clin Nucl Med 2016; 41 (05) 414-416 DOI: 10.1097/RLU.0000000000001139.