AUTHOR=Cortés Mancera Emilly A. , Sinisterra Solis Fabio A. , Romero-Castellanos Francisco R. , Diaz-Meneses Ivan E. , Kerik-Rotenberg Nora E. 

TITLE=18F-FDG PET/CT as a molecular biomarker in the diagnosis of amyotrophic lateral sclerosis associated with prostate cancer and progressive supranuclear palsy: A case report

JOURNAL=Frontiers in Nuclear Medicine

VOLUME=Volume 3 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/nuclear-medicine/articles/10.3389/fnume.2023.1137875

DOI=10.3389/fnume.2023.1137875

ISSN=2673-8880

ABSTRACT=Introduction: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative multisystem disorder. The clinical presentation typically consists of progressive focal muscle atrophy and weakness. In addition to motor disorders, the association between ALS and cancer has been researched, as frontotemporal dementia and progressive supranuclear palsy. Diagnosis is based primarily on clinical history, physical examination, electrodiagnostic tests (with EMG needle), and neuroimaging such as MRI and PET/CT with 18F FDG.
Presentation of the case:  This is a 67-year-old male patient, diagnosed with prostate adenocarcinoma with a clinical picture of muscle weakness in the lower limbs that caused falls, associated with fasciculations in thighs and arms, alterations in the tone of voice, memory and difficulty to articulate words. In the neurological assessment, it was described walking supported by a walker, having decreased strength of both lower limbs and sensitivity without alterations. The diagnoses of upper and lower motor neuro-syndrome and probable amyotrophic lateral sclerosis were integrated. Furthermore, it was considered the probable coexistence of FTD (Frontotemporal Dementia/Disorder) with ALS. The main findings in the PET/CT with 18F-FDG study were hypometabolism in the cortex of the bilateral motor and premotor areas, anterior cingulate, both caudates and putamens, a metabolic pattern compatible with ALS, and progressive supranuclear palsy.
Conclusion: Herein we demonstrate a different case in which ALS, prostate cancer and PSP (Progressive supranuclear palsy) coexisted clinically and with PET (Positron Emission Tomography) studies. Molecular imaging has potential in the diagnostic and prognostic evaluation of ALS. It is crucial to identify the disease early and reliably through metabolic patterns that allow us to confirm the disease or differentiate it from other pathologies.