CASE REPORT article
Front. Med.
Sec. Nuclear Medicine
This article is part of the Research TopicCase Reports in PET imaging 2025View all 4 articles
Unexpected brain metastases from neuroendocrine prostate cancer detected by [18F]fluorocholine PET/CT: a case report
Provisionally accepted
Yassir Benameur1*
Mohcine Hommadi2Omar Ait Sahel1Salah Nabih Oueriagli1,3Ikram Zahfir1,3Meryem Aboussabr1,3Jaafar El Bakkali1Abderrahim Doudouh1,3- 1Department of Nuclear Medicine, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University., Rabat, Morocco
- 2Department of Radiotherapy Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University., Rabat, Morocco
- 3Department of Nuclear Medicine, Hopital Militaire d'Instruction Mohammed V, Rabat, Morocco
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Neuroendocrine prostate cancer (NEPC) is a rare and aggressive variant of prostate carcinoma, often associated with atypical metastatic spread and poor prognosis. Brain metastases from NEPC are exceptional and may pose significant diagnostic challenges. We report the case of a 59-year-old man referred for initial staging of prostate cancer after a transrectal ultrasound-guided biopsy that initially demonstrated poorly differentiated adenocarcinoma. Whole-body [18F]fluorocholine positron emission tomography/computed tomography (PET/CT) revealed subcentimetric hypermetabolic foci in the left frontal and left temporal cortex and in the left cerebellar hemisphere, suggestive of brain metastases. Pelvic lymphadenopathy was also identified, with no evidence of bone or other visceral involvement. Subsequent histopathological re-evaluation of the initial biopsy, including extended immunohistochemical analysis, demonstrated a neuroendocrine (small cell) component. The patient underwent stereotactic radiotherapy for the cerebral lesions and localized radiotherapy for the primary prostatic tumor. This case underscores the diagnostic value of [18F]fluorocholine PET/CT in detecting unexpected metastatic sites in neuroendocrine prostate carcinoma. Early identification of central nervous system involvement may have therapeutic and prognostic implications, emphasizing the need for molecular imaging in atypical or aggressive prostate cancer phenotypes.
Keywords: [18F]fluorocholine PET/CT, brain metastases, case report, hybrid imaging, Molecular Imaging, neuroendocrine prostate cancer, small cell carcinoma
Received: 11 Oct 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Benameur, Hommadi, Ait Sahel, Oueriagli, Zahfir, Aboussabr, El Bakkali and Doudouh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yassir Benameur
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