This 46 yo male patient presented with widespread pain and weight loss. There was no prior history of carcinoma of any kind.
He underwent a whole body bone scan , CXR and CT of the abdomen and pelvis. The results are as follows:
In the delayed images there is exquisite skeletal uptake particularly in the axial skeleton with increased uptake in both proximal humeri and a number of foci of intense uptake in the shaft of the right humerus.
There is absent uptake of tracer by the kidneys and exquisite skeletal uptake – a “super” scan . This is suggestive of diffuse metastatic bone cancer.
The CT revealed extensive sclerosis of the entire bony skeleton. Metastatic lymph nodes pre aortic in the mid abdomen were identified. The prostate was enlarged, quite heterogeneous and bulging in to the bladder base.
The scan appearances are suggestive of prostatic cancer however, PSA levels and prostatic biopsy had not yet been performed.