False-positive MpMRI and True-negative Ga-PSMA PET/CT Xanthogranulomatous Prostatitis: a Case Report

Overview

Journal Transl Androl Urol

Date 2022 May 13

PMID 35558264

Authors

Yongxiang Tang

Jinhui Yang

Chuanchi Zhou

Jian Li

Shuo Hu

Affiliations

Soon will be listed here.

Abstract

Background: Xanthogranulomatous prostatitis (XGP) is a rare disorder of the prostate. It presents as a hard fixed nodule on digital rectal examination (DRE), and may cause obstructive urinary symptoms and elevated serum prostate-specific antigen (PSA) levels, therefore mimicking prostate cancer (PCa) clinically and biochemically. Radiological features of XGP overlap with those of PCa, and the 2 conditions cannot be distinguished by pelvic multiparametric magnetic resonance imaging (mpMRI). Ga-labelled prostate-specific membrane antigen (Ga-PSMA) with positron emission tomography/computed tomography (PET/CT) has shown its potential in the initial diagnosis and staging of PCa; however, the imaging characteristics of XGP on Ga-PSMA PET/CT have yet to be reported.

Case Description: We report the case of a 56-year-old man who had slowly progressing dysuria for 10 years, which was significantly worse for 1 week, and a PSA level of 49.19 ng/L. Ultrasound revealed a hypoechoic lesion in the left periphery of the prostate, which was hypointense with capsular irregularity on axial T2-weighted imaging (T2WI), hyperintense on the diffusion weighted imaging (DWI), and hypointense on the apparent diffusion coefficient (ADC) maps resulting in a Prostate Imaging-Reporting and Data System (PI-RADS) score of 5. The patient was highly suspected of having high-risk PCa and underwent a Ga-PSMA PET/CT for staging. The PET/CT images showed no PSMA uptake in the involved region. Considering that a small proportion of cases of PCa do not express PSMA, a subsequent targeted biopsy was performed, guided by mpMRI. Histopathological examination showed a large number of foamy macrophages in the neutrophile granulocyte infiltrate, and XGP was finally diagnosed. After treatment with antibiotic levofloxacin, the patient's PSA returned to normal, and his dysuria symptoms had disappeared at the 2-month follow-up.

Conclusions: Non-uptake of PSMA in a lesion may still provide information for a diagnosis by exclusion or regular follow-up checks in patients that are highly suspected to have PCa in clinic or on mpMRI.

Citing Articles

Nanoparticle-Based Radioconjugates for Targeted Imaging and Therapy of Prostate Cancer.

Lankoff A, Czerwinska M, Kruszewski M Molecules. 2023; 28(10).

PMID: 37241862 PMC: 10223532. DOI: 10.3390/molecules28104122.

References

Park S, Zacharias C, Harrison C, Fan R, Kunder C, Hatami N . Gallium 68 PSMA-11 PET/MR Imaging in Patients with Intermediate- or High-Risk Prostate Cancer. Radiology. 2018; 288(2):495-505. DOI: 10.1148/radiol.2018172232. View

Mukendi A, Doherty S, Mohanlal R . Xanthogranulomatous prostatitis: A rare mimicker of prostate adenocarcinoma. Clin Case Rep. 2020; 8(1):203-205. PMC: 6982502. DOI: 10.1002/ccr3.2610. View

Ahmed H, El-Shater Bosaily A, Brown L, Gabe R, Kaplan R, Parmar M . Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017; 389(10071):815-822. DOI: 10.1016/S0140-6736(16)32401-1. View

Futterer J, Briganti A, De Visschere P, Emberton M, Giannarini G, Kirkham A . Can Clinically Significant Prostate Cancer Be Detected with Multiparametric Magnetic Resonance Imaging? A Systematic Review of the Literature. Eur Urol. 2015; 68(6):1045-53. DOI: 10.1016/j.eururo.2015.01.013. View

Chen M, Zhang Q, Zhang C, Zhao X, Marra G, Gao J . Combination of Ga-PSMA PET/CT and Multiparametric MRI Improves the Detection of Clinically Significant Prostate Cancer: A Lesion-by-Lesion Analysis. J Nucl Med. 2018; 60(7):944-949. PMC: 6604689. DOI: 10.2967/jnumed.118.221010. View

Riley D, Barber M, Kienle G, Aronson J, von Schoen-Angerer T, Tugwell P . CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017; 89:218-235. DOI: 10.1016/j.jclinepi.2017.04.026. View

Sheikhbahaei S, Afshar-Oromieh A, Eiber M, Solnes L, Javadi M, Ross A . Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging. Eur J Nucl Med Mol Imaging. 2017; 44(12):2117-2136. DOI: 10.1007/s00259-017-3780-7. View

Hicks R, Simko J, Westphalen A, Nguyen H, Greene K, Zhang L . Diagnostic Accuracy of Ga-PSMA-11 PET/MRI Compared with Multiparametric MRI in the Detection of Prostate Cancer. Radiology. 2018; 289(3):730-737. PMC: 6283324. DOI: 10.1148/radiol.2018180788. View

Lee S, Wolfe K, Acher P, Liyanage S . Multiparametric MRI appearances of primary granulomatous prostatitis. Br J Radiol. 2019; 92(1098):20180075. PMC: 6592093. DOI: 10.1259/bjr.20180075. View

10.

Mohan H, Bal A, Punia R, Bawa A . Granulomatous prostatitis--an infrequent diagnosis. Int J Urol. 2005; 12(5):474-8. DOI: 10.1111/j.1442-2042.2005.01068.x. View

11.

Eiber M, Weirich G, Holzapfel K, Souvatzoglou M, Haller B, Rauscher I . Simultaneous Ga-PSMA HBED-CC PET/MRI Improves the Localization of Primary Prostate Cancer. Eur Urol. 2016; 70(5):829-836. DOI: 10.1016/j.eururo.2015.12.053. View

12.

Swingle C, Baumgarten D, Schuster D . Xanthogranulomatous pyelonephritis characterized on PET/CT. Clin Nucl Med. 2005; 30(11):728-9. DOI: 10.1097/01.rlu.0000182262.16796.b3. View

13.

Perera M, Papa N, Roberts M, Williams M, Udovicich C, Vela I . Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigen-avid Lesions: A Systematic Review and.... Eur Urol. 2019; 77(4):403-417. DOI: 10.1016/j.eururo.2019.01.049. View

14.

Valsangkar R, Singh D, Gaur D . Xanthogranulomatous prostatitis: Rare presentation of rare disease. Indian J Urol. 2012; 28(2):204-5. PMC: 3424902. DOI: 10.4103/0970-1591.98468. View

15.

Osca Garcia J, Alfaro Ferreres L, Vera Donoso C, Ruiz Cerda J, Martinez Jabaloyas J, Jimenez Cruz J . [Non-specific granulomatous prostatitis. Relationship and differential diagnosis with prostatic cancer]. Actas Urol Esp. 1994; 18(4):287-90. View

16.

Verma S, Choyke P, Eberhardt S, Oto A, Tempany C, Turkbey B . The Current State of MR Imaging-targeted Biopsy Techniques for Detection of Prostate Cancer. Radiology. 2017; 285(2):343-356. PMC: 5673043. DOI: 10.1148/radiol.2017161684. View

17.

Sachpekidis C, Kopka K, Eder M, Hadaschik B, Freitag M, Pan L . 68Ga-PSMA-11 Dynamic PET/CT Imaging in Primary Prostate Cancer. Clin Nucl Med. 2016; 41(11):e473-e479. DOI: 10.1097/RLU.0000000000001349. View

18.

Corfield J, Perera M, Bolton D, Lawrentschuk N . Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: a systematic review. World J Urol. 2018; 36(4):519-527. DOI: 10.1007/s00345-018-2182-1. View

19.

Kasivisvanathan V, Rannikko A, Borghi M, Panebianco V, Mynderse L, Vaarala M . MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018; 378(19):1767-1777. PMC: 9084630. DOI: 10.1056/NEJMoa1801993. View

20.

Mottet N, van den Bergh R, Briers E, Van den Broeck T, Cumberbatch M, De Santis M . EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2020; 79(2):243-262. DOI: 10.1016/j.eururo.2020.09.042. View