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Reminder of important clinical lesson
MRI for the detection of prostate cancer origin vertebral metastases in the preosteoblastic phase
  1. Swaroop Revannasiddaiah1,
  2. Madhup Rastogi1,
  3. Pragyat Thakur1,
  4. Manoj Kumar Gupta1,
  5. Ashwani Sood2,
  6. Chittranjan Sharma1
  1. 1Department of Radiotherapy & Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
  2. 2Department of Nuclear Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
  1. Correspondence to Dr Swaroop Revannasiddaiah, swarooptheone{at}gmail.com

This report describes the case of a gentleman aged 59 years presenting with low-back pain, who had underwent radical prostatectomy for prostate cancer 8 years ago. On evaluation, a slightly elevated serum alkaline-phosphatase level prompted a search for bone metastases. Although x-ray radiography and a bone scan were apparently normal, an MRI scan revealed the presence of metastatic marrow infiltration in the lumbar vertebrae. The patient subsequently was initiated on therapy with androgen-deprivation therapy and bisphosphonates, and currently enjoys symptom-free and progression-free survival. The images in this paper intend to impress upon the limitations of bone scan and x-ray radiography with regard to the detection of vertebral marrow infiltration in the absence of cortical bone invasion. In addition, a brief review of the pathophysiology of vertebral metastases arising from prostate cancer is included.

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