University of Washington School of Medicine, Seattle, WA

Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC

Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC

Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC

Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC

Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC

Renal Cell Carcinoma, imaging, diagnosis, testicular mass

The use of prostate-specific membrane antigen–positron emission tomography (PSMA-PET) is becoming more widespread for the diagnosis and management of prostate cancer. Here we report a case of oligometastatic renal cell carcinoma (RCC) to the testes diagnosed incidentally on PSMA-PET imaging. This case demonstrates the potential for diagnosis of nonprostate disease with PSMA-PET imaging, as well as the promising nature of PSMA-PET for the diagnosis and surveillance of RCC. In addition, this case report discusses the rare occurrence of oligo-metastatic RCC to the testis.

1. Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clinical cancer research: an official journal of the American Association for Cancer Research. 1997;3(1):81–85.
2. Spatz S, Tolkach Y, Jung K, Stephan C, Busch J, Ralla B, Rabien A, et al. Comprehensive Evaluation of Prostate Specific Membrane Antigen Expression in the Vasculature of Renal Tumors: Implications for Imaging Studies and Prognostic Role. J Urol. 2018 Feb;199(2):370–377. https://doi.org/10.1016/j.juro.2017.08.079
3. Kang DE, White Jr RL, Zuger JH, Sasser HC, Teigland CM. Clinical use of fluorodeoxyglucose F 18 positron emission tomography for detection of renal cell carcinoma. The Journal of Urol. 2004;171(5):1806–1809. https://doi.org/10.1097/01.ju.0000120241.50061.e4
4. O’Keefe DS, Su SL, Bacich DJ, Horiguchi Y, Luo Y, Powell CT, Zandvliet D, et al. Mapping, genomic organization and promoter analysis of the human prostate specific membrane antigen gene. Biochim. Biophys. Acta. 1998;1443:113–127. https://doi.org/10.1016/S0167-4781(98)00200-0
5. Chang SS, O’Keefe DS, Bacich DJ, Reuter VE, Heston WD, Gaudin PB. Prostate-specific membrane antigen is produced in tumor-associated neovasculature. Clinical Cancer Res. 1999;5(10):2674–681.
6. Barbosa FG, Queiroz MA, Nunes RF, Costa LB, Zaniboni EC, Marin JFG, et al. Nonprostatic diseases on PSMA PET imaging: a spectrum of benign and malignant findings. Cancer Imag. 2020;20(1):23. https://doi.org/10.1186/s40644-020-00300-7
7. Rhee H, Blazak J, Tham CM, Ng KL, Shepherd B, Lawson M, et al. Pilot study: use of gallium-68 PSMA PET for detection of metastatic lesions in patients with renal tumour. EJNMMI Res. 2016 Dec;6(1):76. https://doi.org/10.1186/s13550-016-0231-6
8. Rowe SP, Gorin MA, Hammers HJ, Javadi MS, Hawasli H, Szabo Z, et al. Imaging of metastatic clear cell renal cell carcinoma with PSMA-targeted F-DCFPyL PET/CT. Ann Nucl Med. 2015;29(10):877–82. https://doi.org/10.1007/s12149-015-1017-z
9. Meyer AR, Carducci MA, Denmeade SR, Markowski MC, Pomper MG, Pierorazio PM, et al. Improved identification of patients with oligometastatic clear cell renal cell carcinoma with PSMA-targeted 18F-DCFPyL PET/CT. Ann Nucl Med. 2019 Aug;33(8):617–623. https://doi.org/10.1007/s12149-019-01371-8
10. Udovicich C, Callahan J, Bressel M, Ong WL, Perera M, Tran B, Azad A, et al. Impact of Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in the Management of Oligometastatic Renal Cell Carcinoma. Eur. Urol. Open. Sci. 2022 Aug 29;44:60–68. https://doi.org/10.1016/j.euros.2022.08.001
11. Gao J, Xu Q, Fu Y, He K, Zhang C, Zhang Q, et al. Comprehensive evaluation of 68GaPSMA-11 PET/CT parameters for discriminating pathological characteristics in primary clear-cell Renal Cell Carcinoma. Eur J Nucl Med Mol Imaging. 2020;482(48):561–569. https://doi.org/10.1007/s00259-020-04916-6
12. Mittlmeier, L.M., Unterrainer, M., Rodler, S. et al. 18F-PSMA-1007 PET/CT for response assessment in patients with metastatic renal cell carcinoma undergoing tyrosine kinase or checkpoint inhibitor therapy: preliminary results. Eur J Nucl Med Mol Imaging. 2021;48:2031–2037. https://doi.org/10.1007/s00259-020-05165-3
13. Bianchi M., Sun M, Jeldres C, Shariat SF, Trinh Q-D, Briganti A, et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Annals of Oncol. 2021;23(4):973–980. https://doi.org/10.1093/annonc/mdr362
14. Dutt N, Bates AW, Baithun, SI. Secondary neoplasms of the male genital tract with different patterns of involvement in adults and children. Histopathology. 2000;37(4): 323–331. https://doi.org/10.1046/j.1365-2559.2000.00983.x
15. Andrea C, Tartarelli G, Martini L, Donati S, Puccinelli P, Amoroso D. Ipsilateral right testicular metastasis from renal cell carcinoma in a responder patient to interleukine‐2 treatment. International J of Urol. 2007;14(3):259–260. https://doi.org/10.1111/j.1442-2042.2007.01674.x