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Detection of primary male breast cancer with PSMA PET scan
Background Primary male breast cancer with a synchronous second primary neoplasm is rare. Prostate-specific membrane antigen (PSMA) PET scan uses a tracer for detection of metastatic prostate cancer. Research has shown PSMA is highly expressed in triple negative breast cancer. Here, we report a case of a 75-year-old male with primary prostate cancer and synchronous primary breast cancer which was discovered on prostate-specific membrane antigen (PSMA) scan. To our knowledge, this is the first case showing primary prostate and primary breast cancer in a male with osseous metastasis identified on PSMA scan.
Case Presentation Patient is a 75-year-old male presenting with PSA of 180. Transrectal ultrasound guided prostate biopsy was positive for Gleason grade group 4 (4+4= 8) prostate cancer in 11 out of 12 cores with extra-prostatic extension. PSMA scan was obtained, showing increased PSMA expression consistent with widespread nodal and osseous metastatic prostate cancer. In addition, there was increased radiotracer uptake within the left breast soft tissue and enlarged left axillary lymph node, which may represent primary breast neoplasm versus metastatic prostate cancer.
A palpable left breast mass in the breast underwent biopsy. Pathology was consistent with invasive ductal carcinoma, grade 1, measuring 11mm in the greater linear extent, ER positive, PR positive, HER2 negative.
Prostate specific acid phosphate (PSAP) and NKX3.1 staining was negative, ruling out metastatic prostate cancer in the breast.
The patient underwent left breast radical mastectomy with axillary contents. Pathology was consistent with invasive moderately differentiated ductal carcinoma 3.6cm (grade 2), adjacent to and arising from encapsulated papillary carcinoma. Margins negative for malignancy. One of fourteen axillary nodes positive for metastasis. Staged as pT2pN1a. Tamoxifen 20mg daily for 5 years and Lupron 45mg q6 months was initiated. PSA will be rechecked q6 months.
Discussion This case is an example of a PSMA scan ordered for evaluation of prostate cancer metastasis incidentally found a primary breast cancer. It is an important case as providers should be aware that uptake in PSMA scans have the potential to be related to a second primary cancer.