The utility of PSMA PET/CT after an initial negative scan: PSMA PET Registry (IMAGE)
Caption
Figure 2: Imaging of 58-year-old man after radical prostatectomy for pT2a pN0 prostate cancer and negative margins, followed by salvage radiotherapy to prostate bed one year later. (A) Maximum-intensity-projection image of initial 18F-DCFPyL (PSMA) PET scan performed after biochemical failure (serum PSA level, 0.57 ng/mL) shows physiologic distribution of radiotracer with no evidence of locoregional or distant recurrence. Patient was observed after baseline PET. (B) Repeat PSMA PET scan one year later (inPET2) was performed with serum PSA level of 2.72 ng/mL, PSA velocity of 0.2 ng/mL/mo, and PSA doubling time of 5.3 mo. Maximum-intensity-projection image of inPET2 shows solitary focus of radiotracer uptake at L1. (C) Axial 18F-DCFPyL PET (right), fused PET/CT (middle), and CT (left) images from inPET2 show focus of radiotracer uptake at L1 vertebral body (SUVmax, 7.7; PSMA score, 2) with corresponding small osteoblastic lesion on CT, in keeping with metastatic deposit. Management was changed from observation to stereotactic radiotherapy to skeletal deposit.
Credit
Image created by Ur Metser, BSc, MD, FRCPC; Professor of Radiology, University of Toronto; Head Division of Molecular Imaging at the Joint Department of Medical Imaging; Princess Margaret Cancer Centre, Toronto, Canada.
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