What PET radiotracer(s) is indicated for the initial staging of unfavorable intermediate risk and high/very high risk prostate cancer?
Ga-68 or F-18 PSMA
F-18 PSMA PET-CT. MIP demonstrates a large area of abnormal intense, heterogenous radiotracer uptake in the deep pelvis, just below the bladder, corresponding to the region of the prostate gland. There is also a single small intense focus of radiotracer avidity just posterior to the physiologic activity in the left ureter and a faint focus of radiotracer avidity in the low left pelvis.
Axial fused PET-CT confirms the large area of intense heterogenous radiotracer in the prostate consistent with known, biopsy proven multifocal primary disease. The punctate intense activity posterior to the left ureter corresponds to a left iliac junctional lymph node. The faint focus of radiotracer in the low left pelvis corresponds to ischium.
CT shows a small sclerotic lesion in the ischium at site of PSMA avidity and the avid left iliac junctional lymph node to be 4 mm in size (short axis).