PSMA PET/CT Interpretation Pitfalls

The prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is increasingly used in the evaluation of prostate cancer. However, PSMA is expressed physiologically in nonprostatic tissues, as well as in other pathological conditions. False-positive PSMA uptake in nonspecific bony lesions, when using ¹⁸F-PSMA tracer; 4) To understand the difference between ¹⁸F and gallium-68 (⁶⁸Ga) PSMA, and pattern of excretion of each tracer as ¹⁸F has predominant hepatobiliary excretion, unlike ⁶⁸Ga which has predominant renal excretion. This work illustrates different pitfalls in PSMA PET/CT interpretation, highlighting the variation in physiological distribution of PSMA activity and uptake in various benign and neoplastic conditions to prevent misinterpretation of such conditions as metastatic prostatic disease.