Abstract

Imaging of bone metastases in prostate cancer has traditionally involved planar Tc-methylene diphosphonate (Tc-MDP) bone scan with or without the use of supplemental tomographic imaging. More recently, NaF positron emission tomography/x-ray computed tomography (PET/CT) has been found to have improved sensitivity and specificity for sites of osseous metastatic involvement. Prostate-specific membrane antigen (PSMA) is a cell surface enzyme that is highly expressed in prostate cancer and has been explored as a target for prostate cancer imaging. In this case report, we found that PSMA-based PET/ CT with the small molecule F-DCFPyL detected a large number of bony lesions that were occult on Tc-MDP bone scan and NaF PET/CT. PSMA-targeted PET/CT may offer improved sensitivity by binding directly to tumor cells, as opposed to localizing to sites of bony reaction. This preliminary finding should be further explored in larger studies.

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