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Bone metastases from poorly differentiated adenocarcinoma of the prostate diagnosed by In-111 ProstaScint (Capromab Pendetide) images with negative results of Tc-99m MDP bone scan and without significant elevation of prostate-specific antigen.

A 60-year-old man with a history of radical prostatectomy for cancer of the prostate (Gleason sum score = 4+5) was evaluated for persistent pelvic pain and a slight increase in his prostate-specific antigen level (0.01 to 0.1 ng/ml). MRI of the lumbosacral spine and pelvis showed no significant abnormality. A Tc-99m MDP whole-body planar bone scanning with SPECT images of the pelvis obtained 2 days later showed no abnormality. In-111 ProstaScint imaging was performed and showed recurrence of disease in the prostate bed. In addition, abnormally increased uptake in the left sacral ala and iliac wing were noted. After 10 days, another MRI of the pelvis showed a soft tissue mass in the left sacral ala, and a CT-guided biopsy revealed poorly differentiated metastatic adenocarcinoma of the prostate. This case shows that poorly differentiated adenocarcinoma of the prostate can metastasize to bones without significant elevation in the serum prostate-specific antigen level.