Prostate cancer recurrence in vas deferens – fusion image guide as an important tool in dignosis

 Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0071


CHALLENGING CLINICAL CASES

Leonardo Guedes Moreira Valle 1, Antônio Rahal Jr. 1, Priscila Mina Falsarella 1, Juliano Ribeiro de Andrade 1, Oren Smaletz 2, Akemi Osawa 3, Rodrigo Gobbo Garcia 1
1 Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil; 2 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil; 3 Departamento de Medicina Nuclear e Radiologia, Hospital Israelita Albert Einstein, São Paulo, Brasil

ABSTRACT

The biochemical recurrence after local treatment for prostate cancer is an often chal­lenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites.

An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA- 68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence.

The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously.

High resolution acquired in PET / MR associated with image fusion allows orienta­tion procedures, even in areas of difficult access, with greater accuracy than con­ventional techniques.

Keywords: Prostatic Neoplasms; Vas Deferens; Therapeutics

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