Perineural Involvement and Lung Metastasis From Hormone-Sensitive Prostate Cancer: Multimodal Imaging With MRI and Dual-tracer PSMA/[18F]FDG PET/CT

Luca Filippi; Eliseo Picchi; Roberta Danieli; Annamaria Lacanfora; Francesco Garaci

doi:10.1097/RLU.0000000000005854

Perineural Involvement and Lung Metastasis From Hormone-Sensitive Prostate Cancer: Multimodal Imaging With MRI and Dual-tracer PSMA/[18F]FDG PET/CT

Clin Nucl Med. 2025 Jul 7. doi: 10.1097/RLU.0000000000005854. Online ahead of print.

Authors

Luca Filippi¹, Eliseo Picchi¹, Roberta Danieli², Annamaria Lacanfora³, Francesco Garaci¹

Affiliations

¹ Department of Biomedicine and Prevention, University of Rome Tor Vergata.
² Department of Human Sciences and Promotion of the Quality of Life, University San Raffael.
³ Nuclear Medicine Unit, Department of Oncohaematology, Fondazione PTV, Policlinico Tor Vergata University Hospital, Rome, Italy.

PMID: 40623137
DOI: 10.1097/RLU.0000000000005854

Abstract

A 66-year-old man with a history of high-grade prostate cancer (PCa), treated with prostatectomy and radiotherapy, experienced rising prostate-specific antigen (PSA) levels and lumbar pain that was unresponsive to analgesics. Magnetic Resonance Imaging (MRI) showed pathological thickening and enhancement of the left S1-S3 nerve roots, as well as an intradural nodule. PET/CT with [18F]F-PSMA-1007 revealed increased uptake in the sacral nerves and a PSMA-negative lung nodule. A subsequent [18F]FDG PET/CT showed FDG uptake in both the sacral plexus and the lung nodule, suggesting diffusely metastatic PCa. In the case we describe, multimodal imaging with MRI and dual-tracer PET/CT was essential to obtain a comprehensive view of tumor extension and biology.

Keywords: dual tracer PET/CT; prostate cancer; prostate specific membrane antigen.