Fig. 2
Example of staging change of PSMA PET/CT compared with conventional imaging. A man presented with a clinical T2c Gleason 7b (predominant Gleason score 4) PCa with an iPSA of 16. Planar BS (a) showed a faint spot in the left proximal femur (red arrow) which was confirmed on SPECT/CT (b) as a sclerotic lesion with osteoblastic activity (red arrow). The lesion was interpreted as suspicious for bone metastasis. Other areas with increased osteoblastic activity (green arrows) were interpreted as degenerative. A [68Ga]PSMA PET/CT (c) 36 days later shows a PSMA positive bilateral PCa (blue arrow), but no PSMA expression in the sclerotic lesion in the left proximal femur (d, red arrow). Based on PSMA PET/CT the lesion in the left proximal femur was regarded as not suspicious for bone metastasis; M stage changed from positive to negative and treatment intent changed from palliative to curative