case_images: PMC11236384_01
case_images: Initial 99mTc bone scintigraphy at the time of prostate cancer diagnosis. Whole-body 99mTc bone scintigraphy showed abnormal uptakes in the bilateral femur, the bilateral scapula, and right rib, suggesting multiple bone metastases, and uptakes in the thoracic vertebra, reflecting nonspecific accumulation for the bone spicule.
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case_images: F1
case_images: T4N1M1 with multiple bone metastases shown by technetium 99m (99mTc) bone scintigraphy (Fig. 1) underwent radiotherapy to the prostate and combined androgen blockade therapy as initial treatments. The PSA value reached the nadir of 3.70 ng/mL.
case_images: 99mTc bone scintigraphy at the time of bone marrow metastasis diagnosis. Whole-body 99mTc bone scintigraphy showed almost no abnormal uptake in the whole body excluding small uptake in the sacrum, reflecting sacral insufficiency fracture.
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case_images: F2
case_images: He underwent technetium 99mTc bone scintigraphy and 11C-choline PET/CT examination to evaluate the patient current disease status for restaging. 99mTc bone scintigraphy showed almost no abnormal uptake in the whole body excluding small uptake in the sacrum reflecting sacral insufficiency fracture (Fig. 2), whereas 11C-choline PET/CT showed diffuse bone marrow 11C-choline uptake (Fig. 3).
case_images: Pathological finding of iliac marrow biopsy. a The iliac bone marrow biopsy (hematoxylin and eosin staining) revealed bone marrow metastasis of adenocarcinoma. b Immunostaining for NKX3.1 was positive.
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case_images: F4
case_images: An iliac bone marrow biopsy was performed, the results of the histopathological examination revealed bone marrow metastasis of adenocarcinoma, and immunostaining for NKX3.1 was positive (Fig. 4). Although docetaxel therapy was started, PSA value continued rising (to 170 ng/mL at 1 month later, 282 ng/mL at 2 months later, 477 ng/mL at 3 months later, and 668 ng/mL at 4 months later), and he died after 4 months of the diagnosis.