Metastatic superscan in 18F PSMA PET/CT of a patient with prostate carcinoma

A biopsy proven patient of prostate carcinoma, age 70 years, was referred to department of Nuclear Medicine for radionuclide-based therapy. His PSA levels were > 1000ng/ml and prostatic MRI showed enlarged prostate with heterogeneous signal and size 3.8x3.7x3.5cms with few small heterogeneous nodular signals in the transition zone. He was planned for 18F Prostate Specific Membrane Antigen (PSMA) PET/CT scan prior to therapy. The 18F PSMA PET/CT revealed PSMA expressing prostate lesion (SUVmax ~10.2) with extension into urinary bladder along with bilateral supraclavicular, mediastinal, retrocrural, retroperitoneal and pelvic lymph nodes and sclerotic lesion in entire axial and appendicular skeleton.