case_images: PMC9067612_01
case_images: Adenocarcinoma of the prostate with a Gleason score of 3 + 4 = 7 (A, B).
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case_images: Accordingly, prostate cancer was suspected and needle biopsy was performed, followed by confirmation of the adenocarcinoma of the prostate with a Gleason score of 3 + 4 = 7 (Figure 1).
case_images: Prostate MRI revealing prostate cancer with bladder invasion, a marked hyperintensity on T2-weighted imaging [(A) axial, (B) coronal, (C) sagittal], and hypointensity on diffusion-weighted imaging (D).
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case_images: Prostate magnetic resonance imaging (MRI) confirmed prostate cancer with bladder invasion (Figure 2).
case_images: (A) Gross specimen of the prostate with a small bladder tissue. (B) Ileocystoplasty was performed and a new urinary excretory system was reconstructed. (C) H&E staining of bladder invasion lesions showing poorly differentiated prostatic adenocarcinoma with a Gleason score of 5 + 5 = 10. (D) Immunohistochemical staining result, NKX3.1(+).
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case_images: For the reconstruction of the urinary excretory system, ileocystoplasty was performed (Figure 3).
case_images: A 18F-PSMA-1007 PET/CT avid solitary penile lesion with a SUVmax of 6.4 (A, B); no morphological abnormalities of the penis detected on CT imaging (C).
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case_images: Surprisingly, no other PSMA-avid foci were located in the prostatic bed and the pelvis, except for an intense uptake in the corpus cavernosum with a SUVmax of 6.4 (Figure 4).
case_images: Timeline of the PSA level and treatment (green arrow:a positive result of 18F-PSMA-1007 PET/CT imaging with a PSA of 0.072 ng/ml; black arrow:an elevated PSA of 0.032 ng/ml; red arrow:an elevated PSA of 6.79 ng/ml).
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case_images: Subsequently, an elevated PSA level was recorded (0.547 ng/ml) in March 2021 and in July 2021 (6.79 ng/ml) (Figure 5).
case_images: Penile lesion was enlarged with a higher SUVmax of 7.4 (B); meanwhile, systemic bone metastasis was certifified (A). No morphological abnormalities of the penis detected on CT imaging (C).
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case_images: After several months, the patient showed a marked increase in PSA value (>100 ng/ml), combined with penile bleeding. 18F-PSMA-1007 PET/CT revealed that the uptake of penile lesions was significantly higher (SUVmax 7.4) and that the range of lesions was enlarged than earlier; meanwhile, systemic bone metastasis was detected (Figure 6).