Value of CT Morphology in Interpreting Mild 18F-PSMA-1007 Uptake in Prostate Cancer With Biochemical Recurrence After Prostatectomy

Abstract

Early detection of recurrence is critical in patients with rising PSA after radical prostatectomy. The European Association of Urology recommends PSMA PET/CT for patients with PSA >0.2 ng/mL if results may affect management. Despite its advantages, all PSMA radiotracers can show unspecific bone uptake, requiring cautious interpretation. Current criteria for bone metastasis emphasize intense PSMA uptake, with or without CT abnormalities. Yet even mild uptake may represent metastasis when morphologic changes are present. This case underscores the importance of integrating CT morphology when interpreting mild PSMA-avid lesions in the setting of biochemical recurrence after prostatectomy. © 2025