68Ga-PSMA PET/CT False-Positive Tracer Uptake in Paget Disease

Abstract

65-year-old man with left-sided pelvic pain on evaluation was found to have features suggestive of either Paget disease or prostatic bone metastasis of the left hemipelvis based on Tc-MDP bone scan and MRI. Ga-PSMA PET/CT to assess the possibility of primary prostate cancer and if present to stage it helped to rule out prostate cancer because of absence of focal abnormal increased tracer uptake in the prostate gland. However, false-positive tracer uptake was noted in the left hemipelvis, which was subject to biopsy and histopathologically proven to be Paget disease involvement.

68Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

“…A single case study (Table 2) showed intense 68 Ga-PSMA uptake in skeletal regions that appeared to represent Paget's disease, which was confirmed by biopsy (Sasikumar et al, 2016). This case illustrates recent findings (published after the literature search for the present review) that PSMA is expressed in several tissues other than the prostate, such as in the neovasculature of several tumours, for example myeloma (Rauscher et al, 2017), renal cell carcinoma (Rhee et al, 2016a;Zacho et al, 2017).…”

“…However, the DTA was performed for bone assessment in only one study. However, in that study, the CT was suggestive of Paget's disease of the bone, which was confirmed by biopsy (Sasikumar et al, 2016). First, the authors concluded that if a 68 Ga-PSMA PET/CT had been performed, a BS would not be needed, and second, they found 68 Ga-PSMA PET/CT to be superior to BS particularly in primary staging and in biochemical recurrence (Pyka et al, 2016).…”

“…After the full texts of potentially eligible studies were read, 45 papers were included. An overview of the 37 included papers is shown in Table 1 (31 case series) and Table 2, in which six single cases are presented (Chakraborty et al, 2015b;Lawal et al, 2015;Uprimny et al, 2015;Agarwal et al, 2016;Sasikumar et al, 2016;Soydal et al, 2016). Finally, one radiochemistry study was excluded because it reported data from a single patient using 68 Ga-PSMA-11 versus 68 Ga-CHX-A"-DPTA-PSMA PET/CT, an uncommon PET ligand (Wustemann et al, 2016).…”

“…Finally, one radiochemistry study was excluded because it reported data from a single patient using 68 Ga-PSMA-11 versus 68 Ga-CHX-A"-DPTA-PSMA PET/CT, an uncommon PET ligand (Wustemann et al, 2016). An overview of the 37 included papers is shown in Table 1 (31 case series) and Table 2, in which six single cases are presented (Chakraborty et al, 2015b;Lawal et al, 2015;Uprimny et al, 2015;Agarwal et al, 2016;Sasikumar et al, 2016;Soydal et al, 2016). Most of the studies included patients with biochemical recurrence, but some studies included data on staging, whereas, other studies used populations with different stages of prostate cancer.…”

Will GRPR Compete with PSMA as a Target in Prostate Cancer?

“…However, these promising agents do not detect all recurrences (5,7), and other types of cancer also express PSMA (8,9). False-positive findings have also been reported using PSMA agents (10)(11)(12). Given the widespread adoption of PSMA radiopharmaceuticals and their excellent performance at all stages of PCa, is there a need or a role for another class of PET radiopharmaceutical targeting other biologic processes in PCa?…”