False‑positive diagnosis of disease progression by magnetic resonance imaging for response assessment in prostate cancer 
with bone metastases: A case report and review of the pitfalls of images in the literature

Yu,Yi‑Shan; Li,Wan‑Hu; Li,Ming‑Huan; Meng,Xue; Kong,Li; Yu,Jin‑Ming

doi:10.3892/ol.2015.3753

False‑positive diagnosis of disease progression by magnetic resonance imaging for response assessment in prostate cancer with bone metastases: A case report and review of the pitfalls of images in the literature

Authors:
- Yi‑Shan Yu
- Wan‑Hu Li
- Ming‑Huan Li
- Xue Meng
- Li Kong
- Jin‑Ming Yu
View Affiliations

Affiliations: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong 250117, P.R. China, Department of Radiology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong 250117, P.R. China
Published online on: September 25, 2015 https://doi.org/10.3892/ol.2015.3753
Pages: 3585-3590

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Bone metastases are common in prostate cancer. However, differentiating neoplastic from non‑neoplastic alterations of bone on images is challenging. In the present report, a rare case of bone marrow reconversion on magnetic resonance imaging (MRI) assessment, which may lead to a false‑positive diagnosis of disease progression of bone metastases in hormone‑resistant prostate cancer, is presented. Furthermore, a review of the literature regarding the pitfalls of images for response assessment, including the ‘flare’ phenomenon on bone scintigraphy, computed tomography (CT), positron emission tomography/CT and marrow reconversion on MRI is also provided. These inaccuracies, which may lead to a premature termination of an efficacious treatment, should be carefully considered by the radiologists and oncologists involved in clinical trials. The case reported in the present study showed how to assess the early therapeutic response and select the appropriate treatment for the patient when these pitfalls are encountered on clinical images.

View Figures

View References

1	Bashir MN: Epidemiology of Prostate Cancer. Asian Pac J Cancer Prev. 16:5137–5141. 2015.PubMed/NCBI
2	Cooper CR, Chay CH, Gendernalik JD, Lee HL, Bhatia J, Taichman RS, McCauley LK, Keller ET and Pienta KJ: Stromal factors involved in prostate carcinoma metastasis to bone. Cancer. 97(Suppl): 739–747. 2003. View Article : Google Scholar : PubMed/NCBI
3	Carlin BI and Andriole GL: The natural history, skeletal complications and management of bone metastases in patients with prostate carcinoma. Cancer. 88(Suppl): 2989–2994. 2000. View Article : Google Scholar : PubMed/NCBI
4	Pollen JJ, Witztum KF and Ashburn WL: The flare phenomenon on radionuclide bone scan in metastatic prostate cancer. AJR Am J Roentgenol. 142:773–776. 1984. View Article : Google Scholar : PubMed/NCBI
5	Messiou C, Cook G, Reid AH, Attard G, Dearnaley D, de Bono JS and de Souza NM: The CT flare response of metastatic bone disease in prostate cancer. Acta Radiol. 52:557–561. 2011. View Article : Google Scholar : PubMed/NCBI
6	Ryan CJ, Shah S, Efstathiou E, Smith MR, Taplin ME, Bubley GJ, Logothetis CJ, Kheoh T, Kilian C, Haqq CM, et al: Phase II study of abiraterone acetate in chemotherapy-naive metastatic castration-resistant prostate cancer displaying bone flare discordant with serologic response. Clin Cancer Res. 17:4854–4861. 2011. View Article : Google Scholar : PubMed/NCBI
7	Tombal B, Rezazadeh A, Therasse P, Van Cangh PJ, Van de Berg B and Lecouvet FE: Magnetic resonance imaging of the axial skeleton enables objective measurement of tumor response on prostate cancer bone metastases. Prostate. 65:178–187. 2005. View Article : Google Scholar : PubMed/NCBI
8	Berthold DR, Pond G, De Wit R, Eisenberger MA and Tannock IF: Association of pain and quality of life (QOL) response with PSA response and survival of patients (pts) with metastatic hormone refractory prostate cancer (mHRPC) treated with docetaxel or mitoxantrone in the TAX-327 study. J Clin Oncol. 24:45162006.PubMed/NCBI
9	Berthold DR, Pond GR, de Wit R, Eisenberger MA and Tannock IF: TAX 327 Investigators: Survival and PSA response of patients in the TAX 327 study who crossed over to receive docetaxel after mitoxantrone or vice versa. Ann Oncol. 19:1749–1753. 2008. View Article : Google Scholar : PubMed/NCBI
10	Greenburg EJ, Chu FC, Dwyer AJ, Ziminski EM, Dimich AB and Laughlin JS: Effects of radiation therapy on bone lesions as measured by 47 Ca and 85 Sr local kinetics. J Nucl Med. 13:747–751. 1972.PubMed/NCBI
11	Messiou C, Cook G and de Souza NM: Imaging metastatic bone disease from carcinoma of the prostate. Br J Cancer. 101:1225–1232. 2009. View Article : Google Scholar : PubMed/NCBI
12	Scher HI, Halabi S, Tannock I, Morris M, Sternberg CN, Carducci MA, Eisenberger MA, Higano C, Bubley GJ, Dreicer R, et al: Prostate Cancer Clinical Trials Working Group: Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: Recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol. 26:1148–1159. 2008. View Article : Google Scholar : PubMed/NCBI
13	Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN and Ueno NT: Bone imaging in metastatic breast cancer. J Clin Oncol. 22:2942–2953. 2004. View Article : Google Scholar : PubMed/NCBI
14	Pollen JJ and Shlaer WJ: Osteoblastic response to successful treatment of metastatic cancer of the prostate. AJR Am J Roentgenol. 132:927–931. 1979. View Article : Google Scholar : PubMed/NCBI
15	Hashisako M, Wakamatsu K, Ikegame S, Kumazoe H, Nagata N and Kajiki A: Flare phenomenon following gefitinib treatment of lung adenocarcinoma with bone metastasis. J Exp Med. 228:163–168. 2012.
16	Cook GJ, Venkitaraman R, Sohaib AS, Lewington VJ, Chua SC, Huddart RA, Parker CC, Dearnaley DD and Horwich A: The diagnostic utility of the flare phenomenon on bone scintigraphy in staging prostate cancer. Eur J Nucl Med Mol Imaging. 38:7–13. 2011. View Article : Google Scholar : PubMed/NCBI
17	Janicek MJ, Hayes DF and Kaplan WD: Healing flare in skeletal metastases from breast cancer. Radiology. 192:201–204. 1994. View Article : Google Scholar : PubMed/NCBI
18	Lecouvet FE, Geukens D, Stainier A, Jamar F, Jamart J, d'Othée BJ, Therasse P, Van de Berg B and Tombal B: Magnetic resonance imaging of the axial skeleton for detecting bone metastases in patients with high-risk prostate cancer: Diagnostic and cost-effectiveness and comparison with current detection strategies. J Clin Oncol. 25:3281–3287. 2007. View Article : Google Scholar : PubMed/NCBI
19	Hartman RP, Sundaram M, Okuno SH and Sim FH: Effect of granulocyte-stimulating factors on marrow of adult patients with musculoskeletal malignancies: Incidence and MRI findings. AJR Am J Roentgenol. 183:645–653. 2004. View Article : Google Scholar : PubMed/NCBI
20	Long SS, Yablon CM and Eisenberg RL: Bone marrow signal alteration in the spine and sacrum. AJR Am J Roentgenol. 195:W178–W200. 2010. View Article : Google Scholar : PubMed/NCBI
21	Vogler JB III and Murphy WA: Bone marrow imaging. Radiology. 68:679–693. 1988. View Article : Google Scholar
22	Kricun ME: Red-yellow marrow conversion: Its effect on the location of some solitary bone lesions. Skeletal Radiol. 14:10–19. 1985. View Article : Google Scholar : PubMed/NCBI
23	Johnston KL, Farnen JP, Manske BR and Go RS: Abnormal positron emission tomography (PET) scan secondary to the use of hematopoietic growth factors. Haematologica. 90:EIM032005.PubMed/NCBI
24	Seiderer M, Staebler A and Wagner H: MRI of bone marrow: Opposed-phase gradient-echo sequences with long repetition time. Eur Radiol. 9:652–661. 1999. View Article : Google Scholar : PubMed/NCBI
25	Disler DG, McCauley TR, Ratner LM, Kesack CD and Cooper JA: In-phase and out-of-phase MR imaging of bone marrow: Prediction of neoplasia based on the detection of coexistent fat and water. AJR Am J Roentgenol. 69:1439–1447. 1997. View Article : Google Scholar
26	Altehoefer C, Bertz H, Ghanem NA and Langer M: Extent and time course of morphological changes of bone marrow induced by granulocyte-colony stimulating factor as assessed by magnetic resonance imaging of healthy blood stem cell donors. J Magn Reson Imaging. 14:141–145. 2001. View Article : Google Scholar : PubMed/NCBI
27	Scher HI, Kelly WM, Zhang ZF, Ouyang P, Sun M, Schwartz M, Ding C, Wang W, Horak ID and Kremer AB: Post-therapy serum prostate-specific antigen level and survival in patients with androgen-independent prostate cancer. J Natl Cancer Inst. 91:244–251. 1999. View Article : Google Scholar : PubMed/NCBI
28	Nelius T, Klatte T, de Riese W and Filleur S: Impact of PSA flare-up in patients with hormone-refractory prostate cancer undergoing chemotherapy. Int Urol Nephrol. 40:97–104. 2008. View Article : Google Scholar : PubMed/NCBI
29	Sartor O, Reid RH, Hoskin PJ, Quick DP, Ell PJ, Coleman RE, Kotler JA, Freeman LM and Olivier P: Quadramet 424Sm10/11 Study Group: Samarium-153-Lexidronam complex for treatment of painful bone metastases in hormone-refractory prostate cancer. Urology. 63:940–945. 2004. View Article : Google Scholar : PubMed/NCBI