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FRONTIERS IN MEDICAL CASE REPORTS - Volume 5; Issue 1, (Jan-Feb, 2024)

Pages: 01-06

Radiation-Induced Brain Necrosis: The Role of The PSMA PET/CT Evaluation - Case Report

Anna Carolina Borges da Silva, Marcos Paulo Freire

Category: Medical Case Reports

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This is a case of a 69-year-old patient with Prostate Cancer (PCa) who underwent PSMA PET in three different evaluation scenarios: Biochemical Relapse (BCR), response assessment and differential diagnosis between Radiation-induced Brain Necrosis (RBN), and neoplastic tissue viability. PSMA PET showed superiority compared to conventional imaging exams in all scenarios and impacted on the management of the patient.

Keywords: PSMA, PET/CT, Prostate Cancer, Biochemical Relapse, Response Assessment, Radiation Necrosis


Alipour R, Azad A, Hofman MS. Guiding management of therapy in prostate cancer: time to switch from conventional imaging to PSMA PET? Ther Adv Med Oncol 2019; 11: 1758835919876828.

Baum RP, Nanni C. Prostate Cancer Imaging and Therapy, An Issue of PET Clinics. Elsevier Health Sciences; 2017.

da Silva ACB, de Toledo LGM, de Carvalho Fernandes R, Ziroldo AR, Sawczyn GV, Alarcon ST, Lewin F. Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System. Ann Surg Oncol 2023; 30: 4541-4549.

Donswijk ML, van Leeuwen PJ, Vegt E, Cheung Z, Heijmink SWTPJ, van der Poel HG, Stokkel MPM. Clinical impact of PSMA PET/CT in primary prostate cancer compared to conventional nodal and distant staging: a retrospective single center study. BMC Cancer 2020; 20: 723.

Gafita A, Djaileb L, Rauscher I, Fendler WP, Hadaschik B, Rowe SP, Herrmann K, Calais J, Rettig M, Eiber M, Weber M, Benz MR, Farolfi A. Response Evaluation Criteria in PSMA PET/CT (RECIP 1.0) in Metastatic Castration-resistant Prostate Cancer. Radiology 2023; 308: e222148.

INCA, (2023). Instituto Nacional de Câncer - INCA. Available online on:;

Kase AM, Tan W, Copland JA 3rd, Cai H, Parent EE, Madan RA. The Continuum of Metastatic Prostate Cancer: Interpreting PSMA PET Findings in Recurrent Prostate Cancer. Cancers (Basel) 2022; 14: 1361.

McBean R, Tatkovic A, Wong DC. Intracranial Metastasis from Prostate Cancer: Investigation, Incidence, and Imaging Findings in a Large Cohort of Australian Men. J Clin Imaging Sci 2021; 11: 24.

NCCN (2023). NCCN. [Consultado em 18 de janeiro de 2024]. Disponível em:;

Noto B, Auf der Springe K, Huss S, Allkemper T, Stegger L. Prostate-Specific Membrane Antigen-Negative Metastases-A Potential Pitfall in Prostate-Specific Membrane Antigen PET. Clin Nucl Med 2018; 43: e186-e188.

Petersen LJ, Gade M, Fonager RF, Albertsen S, Fledelius J, Ejlersen JA, Christensen MH, Aleksyniene R, Zacho HD. Response evaluation of bone metastasis in prostate cancer: Preliminary comparison of computerized bone scan index versus standardized clinical criteria. Hell J Nucl Med 2021; 24: 2-9.

Pozdnyakov A, Kulanthaivelu R, Bauman G, Ortega C, Veit-Haibach P, Metser U. The impact of PSMA PET on the treatment and outcomes of men with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26: 240-248.

Pyka T, Okamoto S, Dahlbender M, Tauber R, Retz M, Heck M, Tamaki N, Schwaiger M, Maurer T, Eiber M. Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer. Eur J Nucl Med Mol Imaging 2016; 43: 2114-2121.

Rayamajhi SJ, Ponisio MR, Siegel B. Use of 18 F-PSMA PET to Distinguish Cerebral Radiation Necrosis from Tumor Recurrence. Clin Nucl Med 2023; 48: e483-e484.

Shagera QA, Artigas C, Karfis I, Critchi G, Chanza NM, Sideris S, Peltier A, Paesmans M, Gil T, Flamen P. 68Ga-PSMA PET/CT for Response Assessment and Outcome Prediction in Metastatic Prostate Cancer Patients Treated with Taxane-Based Chemotherapy. J Nucl Med 2022; 63: 1191-1198.

Sharma A, Kumar R. Metabolic Imaging of Brain Tumor Recurrence. AJR Am J Roentgenol 2020; 215: 1199-1207.

Thomas L, Balmus C, Ahmadzadehfar H, Essler M, Strunk H, Bundschuh RA. Assessment of bone metastases in patients with prostate cancer-A comparison between 99mTc-bone-scintigraphy and [68Ga] Ga-PSMA PET/CT. Pharmaceuticals 2017; 10: 68.