Potential Pitfall of Fluciclovine PET/CT in Castrate-Resistant Prostate Cancer With Adrenal Metastasis

An 83-year-old man with castrate-resistant prostate cancer underwent an 18 F-fluciclovine PET/CT scan, which was negative for local disease recurrence or locoregional lymphadenopathy, but there were multiple fluciclovine-avid bone metastases. In addition, mildly avid bilateral adrenal nodules were t...

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Bibliographic Details
Published in:Clinical nuclear medicine 2022-12, Vol.47 (12), p.1061-1062
Main Authors: Qi, Jin, Nguyen, Nghi C
Format: Article
Language:English
Subjects:
Aged, 80 and over
Carboxylic Acids
Cyclobutanes
Humans
Male
Neoplasm Recurrence, Local
Positron Emission Tomography Computed Tomography
Prostatic Neoplasms - diagnostic imaging
Prostatic Neoplasms - pathology
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Summary:An 83-year-old man with castrate-resistant prostate cancer underwent an 18 F-fluciclovine PET/CT scan, which was negative for local disease recurrence or locoregional lymphadenopathy, but there were multiple fluciclovine-avid bone metastases. In addition, mildly avid bilateral adrenal nodules were thought to be benign. However, on follow-up PET/CT 10 months later, while on additional therapy with enzalutamide, the bilateral nodules became mass lesions with interval decreased fluciclovine avidity. Adrenal metastases were suspected given their rapid growth, with subsequent CT-guided biopsy revealing metastatic prostate cancer without tumor necrosis. This false-negative case highlights the diagnostic challenge of fluciclovine PET in characterizing adrenal lesions.
ISSN:0363-9762
1536-0229
DOI:10.1097/RLU.0000000000004373