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Prostate-Specific Membrane Antigen PET/CT in Splenic Sarcoidosis
Carsten Kobe1, David Maintz, Thomas Fischer
1From the Departments of *Nuclear Medicine and †Radiology, University Hospital of Cologne, Cologne, Germany.
Clinical Nuclear Medicine
|May 29, 2015
Summary
Prostate cancer relapse can present with unusual findings on imaging. Gallium-68 prostate-specific membrane antigen (Ga-PSMA) PET/CT showed spleen uptake, initially suspicious for metastasis, but biopsy confirmed benign granulomatous disease.
Area of Science:
- Nuclear medicine
- Oncologic imaging
- Pathology
Background:
- Prostate cancer biochemical relapse necessitates accurate staging.
- Prostate-specific membrane antigen (PSMA) PET/CT offers superior sensitivity for detecting recurrent prostate cancer compared to choline PET.
- Identifying the precise location of disease recurrence is critical for treatment planning.
Observation:
- A 65-year-old man with a history of prostate cancer exhibited rising prostate-specific antigen (PSA) levels, indicating biochemical relapse.
- Gallium-68 PSMA PET/CT revealed focal, intense tracer uptake in the spleen, an atypical site for prostate cancer metastasis.
- Despite advanced imaging (PSMA PET/CT and MRI), the nature of the splenic lesion remained indeterminate, raising suspicion for malignancy.
Findings:
- Biopsy of the splenic lesion definitively diagnosed benign granulomatous disease, not prostate cancer metastasis.
- This case highlights a rare instance where PSMA PET/CT identified a benign splenic condition mimicking metastatic disease.
- The intense focal uptake on PSMA PET/CT, while suspicious, ultimately represented a non-malignant pathology.
Implications:
- PSMA PET/CT, while highly sensitive, may detect benign conditions that mimic metastatic disease, necessitating careful interpretation.
- In cases of atypical findings on PSMA PET/CT, especially in unusual locations, biopsy remains the gold standard for definitive diagnosis.
- Understanding potential false positives in PSMA PET/CT imaging is crucial for avoiding unnecessary aggressive treatments in prostate cancer patients.
