Tracer — PSMA PET/CT
PSMA PET/CT Cases
Prostate-specific membrane antigen imaging for staging, biochemical recurrence, and theranostic eligibility. Cases added regularly.
Biochemical RecurrencemiPSMA ScoreInitial StagingLu-177 PSMAPSMA-Negative DiseaseCeliac Ganglia Pitfall
PSMA PET is indicated for initial staging of high-risk prostate cancer, with studies demonstrating improved detection of nodal and distant disease compared to conventional imaging.
Cases Coming Soon
High-Risk Primary Staging
Gleason ≥8 or PSA >20Pelvic nodal assessmentRetroperitoneal nodesBone metastases detection
Cases Coming Soon
vs Conventional Imaging
PSMA vs CT sensitivityPSMA vs bone scanProPSMA trial resultsManagement change rate
Cases Coming Soon
M1 Disease Characterization
Oligometastatic vs polymetastaticBone vs nodal dominantVisceral metastasesTreatment implications
⚠️ Pitfalls & Normal Variants — Cases Coming Soon
Staging Pitfalls
Celiac ganglia — mimic retroperitoneal nodesPhysiologic bladder activitySalivary gland uptake — normalBone islands vs metastases
PSMA PET detects recurrence at PSA levels where conventional imaging is almost always negative. Detection rates at PSA 0.5–1.0 ng/mL approximately 50–75%.
Cases Coming Soon
Post-Prostatectomy BCR
PSA thresholds for detectionProstate bed recurrencePelvic nodal BCRDistant BCRSalvage RT planning
Cases Coming Soon
Post-Radiation BCR
Local recurrenceNodal recurrenceSalvage prostatectomy planningSBRT for oligorecurrence
Cases Coming Soon
Oligometastatic Recurrence
1–3 lesionsSalvage lymph node dissectionStereotactic body RTMDT decision-making
⚠️ Pitfalls & Normal Variants — Cases Coming Soon
BCR Pitfalls
Very low PSA — lower detection rateCeliac ganglia mimicryPost-biopsy inflammatory uptakeBladder diverticulum
PSMA PET is the eligibility gatekeeper for Lu-177 PSMA-617 (PLUVICTO). miPSMA scoring ≥3 at all sites required.
Cases Coming Soon
PLUVICTO Eligibility Assessment
miPSMA score 1–5All lesions must be ≥3VISION trial criteriamCRPC settingPrior taxane & ARPI required
Cases Coming Soon
Post-Therapy Response
PSA responseImaging response criteriaMixed responseProgression patterns
Cases Coming Soon
PSMA-Negative Disease
Neuroendocrine differentiationPSMA loss on ARPIFDG discordanceRebiopsy implicationsAlternative therapies
⚠️ Pitfalls & Normal Variants — Cases Coming Soon
Theranostics Pitfalls
Single PSMA-negative lesion excludes therapyNE differentiation — check FDGPost-therapy stunningPseudo-flare on early scan
PSMA is expressed in normal tissues. Knowing physiologic distribution prevents false-positive interpretation.
Cases Coming Soon
Physiologic PSMA Uptake
Salivary glands — highestLacrimal glandsLiver & spleenKidneys & bladderSmall bowel
Cases Coming Soon
Celiac Ganglia — The Classic Pitfall
Bilateral paraaortic locationMimics retroperitoneal nodesCT morphology — no nodal massCharacteristic location at celiac axis
Cases Coming Soon
Benign Conditions with PSMA Uptake
Ganglia throughout bodyPaget's disease of boneHaemangiomaSchwannomaBPH — variable
Key References & Resources