We present a case of a 61-year-old man with history of prostate cancer and rising PSA levels referred for restaging. Ga-PSMA-11 PET/CT identified 2 lung nodules with low and moderate PSMA uptake. Subsequent F-FDG PET/CT showed high hypermetabolism in the nodule with low PSMA uptake, and low hypermetabolism in the nodule with moderate PSMA uptake. The isolated pulmonary findings and metabolic appearance is an atypical presentation of prostate cancer metastases and raised concern for a second primary malignancy. Fine-needle aspiration of the F-FDG active lung nodule confirmed metastatic prostatic adenocarcinoma that subsequently responded to androgen deprivation therapy and abiraterone acetate.
Clinical nuclear medicine. 2018 Nov 03 [Epub ahead of print]
Paola M Perez, Thomas A Hope, Spencer C Behr, Annemieke van Zante, Eric J Small, Robert R Flavell
From the Departments of Radiology and Biomedical Imaging., Pathology, and., Medicine, University of California, San Francisco, CA.