{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:00:32Z","timestamp":1790290832317,"version":"4.1.0"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T00:00:00Z","timestamp":1763856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World J Nucl Med"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>AbstrAct<\/jats:title>\n                  <jats:p>Precision oncology leverages molecular profiling to tailor cancer treatment, with nuclear medicine playing an increasingly central role, particularly in elderly patients, where noninvasive approaches are preferable. We present a case of a 76-year-old male with metastatic prostate carcinoma (Gleason score: 5\u2009+\u20095\u2009=\u200910) exhibiting neuroendocrine differentiation. Imaging with multiple positron emission tomography (PET) tracers\u201468Ga-PSMA, 18F-FDG, 68Ga-DOTATATE, and 68Ga-FAPI\u2014revealed significant tumor heterogeneity. Tumor heterogeneity is multifactorial, influenced not only by genetic changes but also by epigenetic, microenvironmental, and therapeutic pressures. While 68Ga-PSMA PET\/computed tomography (CT) showed variable expression in osteosclerotic lesions, 18F-FDG PET\/CT detected metabolic activity, and 68Ga-DOTATATE PET\/CT confirmed low somatostatin receptor expression. Despite 177Lu-PSMA radioligand therapy, the disease progressed with rising prostate-specific antigen levels. Subsequent gastrointestinal symptoms led to the diagnosis of sigmoid colon adenocarcinoma, confirmed by 68Ga-FAPI PET\/CT. This case exemplifies the critical role of nuclear imaging in characterizing tumor biology, guiding therapeutic strategies, and reducing reliance on invasive procedures. The integration of multi-tracer PET imaging enabled a nuanced understanding of tumor evolution, reinforcing nuclear medicine's importance in precision oncology and the management of complex, heterogeneous malignancies.<\/jats:p>","DOI":"10.1055\/s-0045-1813676","type":"journal-article","created":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T23:30:17Z","timestamp":1763940617000},"page":"271-274","source":"Crossref","is-referenced-by-count":0,"title":["Precision Medicine in Action: Multi-Tracer PET\/CT Uncovers Tumor Heterogeneity and a Synchronous Malignancy"],"prefix":"10.1055","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6173-679X","authenticated-orcid":false,"given":"Siven","family":"Kar","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and PET\/CT, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2353-3028","authenticated-orcid":false,"given":"Harshita","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and PET\/CT, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7629-9016","authenticated-orcid":false,"given":"Vikram R.","family":"Lele","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and PET\/CT, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nusrat","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and PET\/CT, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,11,23]]},"reference":[{"issue":"37","key":"ref1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1200\/EDBK_174176","article-title":"Precision oncology: who, how, what, when, and when not?","volume":"37","author":"L Schwartzberg","year":"2017","journal-title":"Am Soc Clin Oncol Educ Book"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1038\/bjc.2012.581","article-title":"Cancer heterogeneity: implications for targeted therapeutics","volume":"108","author":"R Fisher","year":"2013","journal-title":"Br J Cancer"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.3390\/cancers11091282","article-title":"Exploring tumor heterogeneity using PET imaging: the big picture","volume":"11","author":"C Bailly","year":"2019","journal-title":"Cancers (Basel)"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"83","DOI":"10.21037\/tau-22-813","article-title":"Can 18F-PSMA-7Q PET\/CT replace prostate biopsy for the diagnosis of prostate cancer?-a single-center retrospective study","volume":"12","author":"Y Liu","year":"2023","journal-title":"Transl Androl Urol"},{"issue":"04","key":"ref5","first-page":"273","article-title":"Neuroendocrine differentiation of prostate cancer: a review","volume":"2","author":"V Parimi","year":"2014","journal-title":"Am J Clin Exp Urol"},{"key":"ref6","first-page":"90","article-title":"Neuroendocrine differentiation in prostate cancer: a mechanism of radioresistance and treatment failure","volume":"5","author":"C D Hu","year":"2015","journal-title":"Front Oncol"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1530\/ERC-18-0226","article-title":"Neuroendocrine differentiation of prostate cancer leads to PSMA suppression","volume":"26","author":"M K Bakht","year":"2018","journal-title":"Endocr Relat Cancer"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/RLU.0000000000002013","article-title":"Adenocarcinoma prostate with neuroendocrine differentiation: potential utility of 18F-FDG PET\/CT and 68Ga-DOTANOC PET\/CT over 68Ga-PSMA PET\/CT","volume":"43","author":"G K Parida","year":"2018","journal-title":"Clin Nucl Med"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"801","DOI":"10.2967\/jnumed.119.227967","article-title":"68Ga-FAPI PET\/CT: tracer uptake in 28 different kinds of cancer","volume":"60","author":"C Kratochwil","year":"2019","journal-title":"J Nucl Med"},{"issue":"08","key":"ref10","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.1007\/s00259-020-04769-z","article-title":"Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F] FDG PET\/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer","volume":"47","author":"H Chen","year":"2020","journal-title":"Eur J Nucl Med Mol Imaging"}],"container-title":["World Journal of Nuclear Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1813676.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:31:04Z","timestamp":1790289064000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1813676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,23]]},"references-count":10,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,9,24]]},"published-print":{"date-parts":[[2026,9]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0045-1813676","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1450-1147","1607-3312"],"issn-type":[{"value":"1450-1147","type":"print"},{"value":"1607-3312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,23]]}}}