case_images: PMC10832942_01
case_images: PMC10832942_02
case_images: Baseline gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-PET/CT).. (a) Maximum intensity projection image showing prostate gland and multiple pelvic lymph nodes tracer uptake. (b) Non-contrast CT showing enlarged prostate gland and multiple enlarged pelvic lymph nodes. (c) Fused PET/CT images show large tracer-avid lesion on the right lobe of the prostate gland extending up to the seminal vesicle (marked with *) with standardized uptake value (SUV) maximum of 12.4. There are multiple enlarged lymph nodes (marked with arrows) in the perirectal and bilateral external iliac regions (SUV max of 28.8). The largest lymph node with mass formation is seen in the right external iliac region, extending superiorly up to the right common iliac region measuring approximately 7.6 (anteroposterior) x 4.6 (transverse) cm in size.
case_images: cureus-0016-00000051518-i01.jpg
case_images: PMC10832942_02_cureus-0016-00000051518-i01.jpg
case_images: FIG1
case_images: The largest lymph node was in the right external iliac region, extending superiorly up to the right common iliac region measuring approximately 7.6 cm anteroposteriorly x 4.6 cm transverse dimensions with standardized uptake value (SUV) maximum of 28.8 (Figure 1).
case_images: PMC10832942_03
case_images: Post-therapy gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-PET/CT).. (a) Maximum intensity projection image. (b) Non-contrast CT. (c) Fused PET/CT images show complete resolution of prior PSMA avid seen in the prostate gland extending to the seminal vesicle. No abnormal uptake is seen in the prostate. Near-complete resolution of prior 68Ga-PSMA-avid perirectal and bilateral external iliac lymph nodes. Small bilateral external iliac lymph nodes are seen with no significant tracer uptake, with the largest measuring 1.3 x 1.0 cm at the left external iliac region (white arrow).
case_images: cureus-0016-00000051518-i02.jpg
case_images: PMC10832942_03_cureus-0016-00000051518-i02.jpg
case_images: FIG2
case_images: PSMA-PET which showed complete resolution of prior Ga-68 PSMA-avid lesion in the prostate and pelvic lymph nodes. PSA levels dropped to undetectable levels of <0.01 ng/L at six months after starting hormonal therapy (Figures 2-4).
case_images: Baseline gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-PET/CT) shows a large tracer-avid lesion in the prostate gland's right lobe extending up to the seminal vesicles in the midline with standardized uptake value maximum of 12.4 (white arrow and star). Post-therapy 68Ga-PSMA-PET/CT show complete resolution of prior PSMA-avid seen in the prostate gland.
case_images: cureus-0016-00000051518-i03.jpg
case_images: PMC10832942_03_cureus-0016-00000051518-i03.jpg
case_images: FIG3
case_images: PSMA-PET which showed complete resolution of prior Ga-68 PSMA-avid lesion in the prostate and pelvic lymph nodes. PSA levels dropped to undetectable levels of <0.01 ng/L at six months after starting hormonal therapy (Figures 2-4).
case_images: Prostate-specific antigen (PSA) kinetics displays a rapid fall in serum PSA levels with the start of systemic treatment and continued to be undetectable at the 21-month follow-up since the beginning of treatment (systemic).
case_images: cureus-0016-00000051518-i04.jpg
case_images: PMC10832942_05_cureus-0016-00000051518-i04.jpg
case_images: FIG4
case_images: His current serum PSA levels remain undetectable at <0.01 ng/L (Figure 4).
case_images: PMC10832942_04
case_images: Radiotherapy treatment planning CT images showing targets and organs at risk (color lines) and radiation dose clouds (increasing dose from blue to red).. (a) Axial image at the prostate gland level. (b and c) Axial images at the mid-pelvis level. (d) Axial image at the upper pelvis level. (e) Coronal plane. (f) Dose-volume histograms.
case_images: cureus-0016-00000051518-i05.jpg
case_images: PMC10832942_04_cureus-0016-00000051518-i05.jpg
case_images: FIG5
case_images: CA, USA), treatment was delivered using volumetric-modulated arc therapy, and treatment set-up was verified using cone beam CT before each treatment (Figure 5).
case_images: PMC10832942_05
case_images: Prostate-specific antigen (PSA) kinetics displays a rapid fall in serum PSA levels with the start of systemic treatment and continued to be undetectable at the 21-month follow-up since the beginning of treatment (systemic).
case_images: cureus-0016-00000051518-i04.jpg
case_images: PMC10832942_05_cureus-0016-00000051518-i04.jpg
case_images: FIG4
case_images: His current serum PSA levels remain undetectable at <0.01 ng/L (Figure 4).