False-positive PSMA uptake in Esophagitis: Diagnostic Implications in Prostate Cancer Staging

We present a case of incidental PSMA uptake in the mid-esophagus on 99m Tc-HYNIC-PSMA SPECT/CT in a 67-year-old man undergoing staging for high-grade prostate adenocarcinoma. While uptake in the prostate lesion was expected, unexpected focal avidity was noted in the esophagus. Given the rarity of esophageal metastases from prostate cancer, further evaluation was performed. Contrast-enhanced CT showed esophageal fluid levels, and endoscopy revealed linear ulcers in distal esophagus. Biopsy confirmed mild reflux esophagitis. This case underscores the potential for benign esophageal inflammation to mimic metastatic disease on PSMA imaging. Accurate interpretation requires careful clinical and pathologic correlation to avoid misdiagnosis.