未经证实:黄色肉芽肿性前列腺炎(XGP)是一种罕见的前列腺疾病。它在直肠指检(DRE)上表现为硬固定结节,并可能导致尿路梗阻症状和血清前列腺特异性抗原(PSA)水平升高,因此在临床和生物化学上模仿前列腺癌(PCa)。XGP的放射学特征与PCa的放射学特征重叠,骨盆多参数磁共振成像(mpMRI)无法区分这两种情况。具有正电子发射断层扫描/计算机断层扫描(PET/CT)的68Ga标记的前列腺特异性膜抗原(68Ga-PSMA)已显示出其在PCa的初始诊断和分期中的潜力;但是,XGP在68Ga-PSMAPET/CT上的成像特征尚未见报道。
未经调查:我们报告了一个56岁的男子,他有10年的缓慢进展的排尿困难,一周内明显更糟,PSA水平为49.19ng/L超声显示前列腺左侧有低回声病变,在轴向T2加权成像(T2WI)上为低信号和囊膜不规则,在扩散加权成像(DWI)上,并且在表观扩散系数(ADC)图上为低信号,导致前列腺成像报告和数据系统(PI-RADS)得分为5。该患者高度怀疑患有高危PCa,并接受了68Ga-PSMAPET/CT分期。PET/CT图像显示相关区域无PSMA摄取。考虑到一小部分PCa病例不表达PSMA,随后进行了靶向活检,由MPMRI指导。组织病理学检查显示大量的泡沫巨噬细胞在中性粒细胞浸润,XGP最终被确诊。抗生素左氧氟沙星治疗后,病人的PSA恢复正常,在2个月的随访中,他的排尿困难症状消失了。
UNASSIGNED:对于临床或MPMRI高度怀疑患有PCa的患者,通过排除或定期随访检查,病灶中未摄取PSMA仍可提供诊断信息。
UNASSIGNED: 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). 68Ga-labelled prostate-specific membrane antigen (68Ga-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 68Ga-PSMA PET/CT have yet to be reported.
UNASSIGNED: 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 68Ga-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.
UNASSIGNED: 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.