Román Carvajal: PSMA PET-CT Misinterpretation Leading to Unnecessary Treatment
Román Carvajal/X

Román Carvajal: PSMA PET-CT Misinterpretation Leading to Unnecessary Treatment

Román Carvajal, President of Mexican Society of Urology, shared a post on X:

“Real case: very low-risk prostate cancer (PSA 3.4 ng, Gleason 3+3, 2-12, ISUP 1) appropriate for active surveillance.

A family seeks a second opinion; a surgical oncologist orders a PSMA PET-CT? and refers to medical oncology.

The scan, performed at a low-experience center, is read as metastatic (bone and nodal), leading to unnecessary chemotherapy + ADT + ARPI. When the patient returned to me, the findings did not match the clinical picture, so I recommended a second nuclear medicine review.

Conclusion: rib and cervical ‘lesions’ were inflammatory/benign uptake, not metastases.

Likely technical issue: residual sodium fluoride in an aged PSMA radiotracer causing nonspecific bone uptake. No CT structural correlate. Key takeaway: Integrate clinical context, pathology, and technical quality.”

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