Urinary Reflux Into the Prostate Gland and Seminal Vesicles

Abstract

A 64-year-old man with lung cancer underwent 18F-FDG PET/CT for restaging, which demonstrated intense 18F-FDG uptake in the right lobe of prostate gland and seminal vesicles, indicating a potential prostate cancer. In 68Ga-PSMA PET/CT, intense uptake in the right lobe of prostate gland and seminal vesicles was also observed but decreased in postmictional delayed images. Magnetic resonance imaging showed high signal intensity of urine in the same areas of uptakes. 18F-FDG and 68Ga-PSMA PET/CT findings in the prostate gland and seminal vesicles were considered to be a result of urinary reflux possibly because of the patient’s previous transurethral resection.

An Unexpected Seminal Vesicle Pitfall in PSMA PET

“…PSMA accumulation in prostate and seminal vesicles as a possible cause of transurethral resection has been previously described in a case report. 1 However, in this patient, the use of ceCTU 2 made it possible to confirm that the origin of the PSMA deposit was not due to prostate cancer 3-5 or regional blood flow/vascular permeability, 4 but to urinary elimination of the radiopharmaceutical and its subsequent accumulation in the seminal vesicle due to urinary reflux as a consequence of the previous HoLEP procedure. [6][7][8] This finding shows us that we should be aware that seminal vesicle PSMA uptake can be a false-positive caused by reflux of urine into the seminal vesicles after enucleation of the enlarged prostate with techniques such as HoLEP.…”

“…Reviewing the patient’s medical history, it was noted that he had undergone holmium laser enucleation of the prostate (HoLEP) as treatment of the acute urinary retention. PSMA accumulation in prostate and seminal vesicles as a possible cause of transurethral resection has been previously described in a case report 1 . However, in this patient, the use of ceCTU 2 made it possible to confirm that the origin of the PSMA deposit was not due to prostate cancer 3–5 or regional blood flow/vascular permeability, 4 but to urinary elimination of the radiopharmaceutical and its subsequent accumulation in the seminal vesicle due to urinary reflux as a consequence of the previous HoLEP procedure 6–8 .…”