Is it stage III melanoma, stage IV prostate cancer, or stage IV melanoma with bone and lymph node metastases? This was the question doctors faced recently when an elderly man with PSMA-expressing metastases presented to a German clinic. He had previously been treated for prostate cancer and skin cancer.
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Positron emission tomography (PET) with 68Ga prostate-specific membrane antigen (PSMA) and computed tomography (CT) can detect metastases in prostate cancer. However, PSMA expression can sometimes also occur in other tumors, making it difficult to establish a clear diagnosis.
In 2019, a patient over 70 years of age was diagnosed with melanoma of the left forearm (Breslow depth 1.4 mm, no ulceration [pT2a]). After complete resection, local re-excision was performed with a safety margin of 10 mm. At the patient's request, a sentinel biopsy was not performed at this time.
He was diagnosed with prostate cancer 13 years ago and was treated with radical prostatectomy and salvage radiotherapy due to disease recurrence 5 years after diagnosis.
During screening in 2022, an elevated serum level of prostate-specific antigen (PSA) was detected (0.58 ng/mL) and PSMA-PET/CT was ordered to detect a possible recurrence. This showed two lesions: a markedly enlarged PSMA-positive left axillary lymph node and a PSMA-positive bone lesion in the L5 lumbar vertebral body.
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