Tc-99m HYNIC PSMA may be a useful in imaging of prostate cancer although with a lower sensitivity for lesion detection compared to Ga-68 PSMA PET/CT. Its use is recommended when Ga-68 PSMA is not readily available, in planning radio-guided surgery or the patient is being considered for radio-ligand therapy with Lu-177 PSMA. It performs poorly in detecting small-sized lesions hence its use is not recommended in patients with small volume disease.
68 Ga-labelled prostate-specific membrane antigen (PSMA) is rapidly emerging as a significant step forward in the diagnosis of recurrent prostate cancer, based on the fact that PSMA is a type II transmembrane protein with high expression in prostate carcinoma cells [1,2]. Recently it has been demonstrated to accumulate in metastatic clear-cell renal cell carcinoma [3] and interestingly several studies have provided evidence that PSMA is also expressed in the tumour-associated vasculature of primary breast cancers and distant metastases [4,5].We report the case of a 33-year-old woman with metastatic breast carcinoma who underwent 68 Ga-PSMA and 18 F-FDG PET/CT imaging for restaging and evaluation of the most appropriate therapeutic option. Images demonstrated intense and extensive skeletal uptake in the axial and appendicular skeleton with liver metastases.Concordance of 68 Ga-PSMA and 18 F-FDG lesions suggests that 68 Ga-PSMA may provide helpful prognostic information. Furthermore, 68 Ga-PSMA-avid metastatic sites may in future aid in selecting tumours with high PSMA expression for PSMA-directed therapy.
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