|Year : 2018 | Volume
| Issue : 3 | Page : 261-263
Prostate-specific membrane antigen imaging in recurrent medullary thyroid cancer: A new theranostic tracer in the offing?
Saurabh Arora, Meghana Prabhu, Nishikant Avinash Damle, Chandrasekhar Bal, Praveen Kumar, Harish Nalla, Sreedharan Thankarajan Arun Raj
Department of Nuclear Medicine, AIIMS, New Delhi, India
|Date of Web Publication||11-Jun-2018|
Nishikant Avinash Damle
Department of Nuclear Medicine, AIIMS, Ansari Nagar, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Prostate-specific membrane antigen (PSMA) expression has been shown in neovasculature of various malignancies. Recurrent medullary thyroid cancer (MTC) is difficult to treat. We present the findings on PSMA-positron emission tomography/computed tomography (PET/CT) of a 68-year-old man with MTC, who presented with a recurrent left paratracheal mass and rising calcitonin. The scan revealed significant uptake on PSMA imaging but not on 68Ga-DOTANOC PET/CT. 177Lu-PRRT is one of the therapeutic options in patients with recurrent MTC, but in this case was not possible due to lack of somatostatin receptor expression. Imaging evidence of PSMA expression alerts us to the potential use of 177Lu-DKFZ-PSMA-617 therapy in such patients.
Keywords: 68Ga-DOTANOC, 68Ga-prostate-specific membrane antigen, medullary thyroid carcinoma, positron emission tomography/computed tomography
|How to cite this article:|
Arora S, Prabhu M, Damle NA, Bal C, Kumar P, Nalla H, Arun Raj ST. Prostate-specific membrane antigen imaging in recurrent medullary thyroid cancer: A new theranostic tracer in the offing?. Indian J Nucl Med 2018;33:261-3
|How to cite this URL:|
Arora S, Prabhu M, Damle NA, Bal C, Kumar P, Nalla H, Arun Raj ST. Prostate-specific membrane antigen imaging in recurrent medullary thyroid cancer: A new theranostic tracer in the offing?. Indian J Nucl Med [serial online] 2018 [cited 2022 Jan 20];33:261-3. Available from: https://www.ijnm.in/text.asp?2018/33/3/261/234117
68Ga prostate-specific membrane antigen (PSMA)-positron emission tomography/computed tomography (PET/CT) is commonly used in the management of patients with prostate cancer. This scan has a theranostic role in a selected group of patients as of date. However, PSMA expression has also been reported previously in other malignancies such as breast, bladder, gastric, colon, renal cell carcinoma, rectum, lung, hepatocellular carcinoma, multiple myeloma, and follicular lymphoma and in some nonneoplastic conditions.,,,,,,, Few studies have shown expression of PSMA in thyroid cancer.,,,,177 Lu/90 Y DOTATATE therapy has been used previously in metastatic medullary thyroid cancer (MTC)., Few earlier studies have reported PSMA expression in the endothelium of tumor neovasculature where there is abnormal protein expression and increased transcription of PSMA through activation of the transcriptional enhancer region in endothelial cells. This 68-year-old man with MTC, who earlier underwent total thyroidectomy and left neck dissection as primary surgery and left modified radical neck dissection and radiotherapy for nodal recurrence, had persistently rising calcitonin (doubling time of ~9 months, raised from 36 to 107 ng/mL) and carcinoembryonic antigen level (27 ng/mL). He had recurrence for the second time, and options of surgery and radiotherapy were already exhausted. Option of using vandetanib/cabozantinib was unavailable. The patient also had a negative metaiodobenzylguanidine (MIBG) scan and somatostatin receptor PET/CT [Figure 1]b and [Figure 1]e, which ruled out 131 I MIBG and 177 Lu DOTATATE therapy. To explore the possibility of using 177 Lu-DKFZ-PSMA 617 therapy, he underwent a 68Ga-PSMA PET/CT, which showed soft-tissue density lesion in the left paratracheal region, extending into tracheoesophageal groove with increased PSMA uptake [Figure 1]c and [Figure 1]f “SUVmax-19.7, SUVmax liver-8.0”. The same mass was fluorodeoxyglucose positive [Figure 1]a but showed no significant uptake on 68Ga DOTANOC uptake [Figure 1]b and [Figure 1]e. Further studies will help ascertain the utility of 177 Lu-PSMA-DKFZ-617 in such patients with exhausted treatment options.
|Figure 1: Maximum intensity projection images of 18F-fluorodeoxyglucose (a), 68Ga-DOTANOC (b), 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (c), revealing increased uptake of 18F-fluorodeoxyglucose and 68Ga prostate-specific membrane antigen in the left paratracheal recurrent soft-tissue lesion, but no significant uptake on scan and somatostatin receptor positron emission tomography/computed tomography (thin black arrow). Axial computed tomography (d), fused 68Ga-DOTANOC (e), and 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (f) images reveal soft-tissue density lesion in the left paratracheal region, extending into tracheoesophageal groove (d) with increased prostate-specific membrane antigen uptake (black arrow, “SUVmax-19.7, SUVmax liver-8.0”)|
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Chang SS, Reuter VE, Heston WD, Bander NH, Grauer LS, Gaudin PB, et al.
Five different anti-prostate-specific membrane antigen (PSMA) antibodies confirm PSMA expression in tumor-associated neovasculature. Cancer Res 1999;59:3192-8.
Kinoshita Y, Kuratsukuri K, Landas S, Imaida K, Rovito PM Jr., Wang CY, et al.
Expression of prostate-specific membrane antigen in normal and malignant human tissues. World J Surg 2006;30:628-36.
Shetty D, Loh H, Bui C, Mansberg R, Stevanovic A. Elevated 68Ga prostate-specific membrane antigen activity in metastatic non-small cell lung cancer. Clin Nucl Med 2016;41:414-6.
Taneja S, Taneja R, Kashyap V, Jha A, Jena A. 68Ga-PSMA uptake in hepatocellular carcinoma. Clin Nucl Med 2017;42:e69-70.
Sasikumar A, Joy A, Pillai MR, Nanabala R, Thomas B. 68Ga-PSMA PET/CT imaging in multiple myeloma. Clin Nucl Med 2017;42:e126-e127.
Kanthan GL, Coyle L, Kneebone A, Schembri GP, Hsiao E. Follicular lymphoma showing avid uptake on 68Ga PSMA-HBED-CC PET/CT. Clin Nucl Med 2016;41:500-1.
Bourgeois S, Gykiere P, Goethals L, Everaert H, De Geeter FW. Aspecific uptake of 68GA-PSMA in paget disease of the bone. Clin Nucl Med 2016;41:877-8.
Damle NA, Tripathi M, Chakraborty PS, Sahoo MK, Bal C, Aggarwal S, et al.
Unusual uptake of prostate specific tracer 68
Ga-PSMA-HBED-CC in a benign thyroid nodule. Nucl Med Mol Imaging 2016;50:344-7.
Verburg FA, Krohn T, Heinzel A, Mottaghy FM, Behrendt FF. First evidence of PSMA expression in differentiated thyroid cancer using [68
Ga] PSMA-HBED-CC PET/CT. Eur J Nucl Med Mol Imaging 2015;42:1622-3.
Taywade SK, Damle NA, Bal C. PSMA expression in papillary thyroid carcinoma: Opening a new horizon in management of thyroid cancer? Clin Nucl Med 2016;41:e263-5.
Lütje S, Gomez B, Cohnen J, Umutlu L, Gotthardt M, Poeppel TD, et al.
Imaging of prostate-specific membrane antigen expression in metastatic differentiated thyroid cancer using 68Ga-HBED-CC-PSMA PET/CT. Clin Nucl Med 2017;42:20-5.
Bychkov A, Vutrapongwatana U, Tepmongkol S, Keelawat S. PSMA expression by microvasculature of thyroid tumors – Potential implications for PSMA theranostics. Sci Rep 2017;7:5202.
Derlin T, Kreipe HH, Schumacher U, Soudah B. PSMA expression in tumor neovasculature endothelial cells of follicular thyroid adenoma as identified by molecular imaging using 68Ga-PSMA ligand PET/CT. Clin Nucl Med 2017;42:e173-e174.
Budiawan H, Salavati A, Kulkarni HR, Baum RP. Peptide receptor radionuclide therapy of treatment-refractory metastatic thyroid cancer using (90) Yttrium and (177) Lutetium labeled somatostatin analogs: Toxicity, response and survival analysis. Am J Nucl Med Mol Imaging 2013;4:39-52.
Makis W, McCann K, McEwan AJ. Medullary thyroid carcinoma (MTC) treated with 177Lu-DOTATATE PRRT: A report of two cases. Clin Nucl Med 2015;40:408-12.
Noss KR, Wolfe SA, Grimes SR. Upregulation of prostate specific membrane antigen/folate hydrolase transcription by an enhancer. Gene 2002;285:247-56.