Urology Research & Practice
UROONCOLOGY - Original Article

Revisiting Skull Metastases of Prostate Cancer at Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography Era: PSMA Uptake Characteristics and Oncological Outcomes

1.

Department of Urology, Koç University Faculty of Medicine, Istanbul, Türkiye

2.

Department of Nuclear Medicine, Koç University Faculty of Medicine, Istanbul, Türkiye

3.

Department of Urology, VKF American Hospital, Istanbul, Türkiye

4.

Department of Medical Oncology, VKF American Hospital, Istanbul, Türkiye

5.

Department of Urology, University Medical Center Hamburg-Eppendorf Faculty of Medicine, Hamburg, Germany

6.

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

Urol Res Pract 2024; 50: 275-280
DOI: 10.5152/tud.2025.24164
Read: 115 Downloads: 18 Published: 07 March 2025

Objective: We aimed to evaluate prostate-specific membrane antigen (PSMA) uptake characteristics and the oncological outcomes in patients with skull metastases.

Methods: The records of 345 serial PSMA positron emission tomography (PET)/computed tomography (CT) scans of 96 patients with metastatic prostate cancer (PCa) were evaluated retrospectively. Skull bone metastasis was detected in 18 patients (18/96, 18.7%), with a mean age of 72.4 ± 9.1 years, and in 40 PSMA PET/CT scans (40/345, 11.6%). Involved skull bones, PSMA uptake characteristics, and CT counterparts of metastatic lesions were centrally reviewed. Prostate specific antigen (PSA) levels at the time of skull metastasis detection and PSMA-detected other metastatic lesions were recorded.

Results: All patients with a skull metastasis showed multiple other metastatic bone lesions, and 6 (33.3%) had visceral metastasis. Seven (38.9%) patients had solitary skull lesions, whereas 11 (61.1%) had multiple skull metastases. Twenty-two out of 37 (59.5%) metastatic lesions had no CT counterpart. The median SUVmax was significantly higher in metastatic lesions with a CT counterpart (median 9.09 vs. 4.63, P = .018). At a median follow-up of 23.4 mo (interquartile range [IQR] 8.7-34.1) after detection of skull metastasis, 5 out of 11 (45.5%) hormone-sensitive and all castration-resistant patients died of PCa. The median survival of patients with castration-resistant disease was 9.92 months.

Conclusion: The majority of PSMA-detected skull metastases did not show a CT counterpart, which may explain why skull metastases were rarely detected before the PSMA PET-era. In high-volume metastatic prostatic cancer cases, 68Ga-PSMA PET/CT imaging field including the vertex, may enhance the accuracy in detecting tumor extent and metabolic tumor volume.

Cite this article as: Esen B, Falay O, Tarim K,et"al. Revisiting skull metastases of prostate cancer at prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography era: PSMA uptake characteristics and oncological outcomes. Urol Res Pract.2024;50(5):275-280.

Files
EISSN 2980-1478