Paget disease of bone is said to be at increased risk of metastatic malignancy. In many cases, these metastases are disguised on conventional nuclear bone scan due to the increased bone turnover associated with Paget disease. PSMA (prostate-specific membrane antigen) scanning relies not on bone turnover (osteoclasts and osteoblasts) for positivity but attaches to tumor cells thus it can be used for detection in areas of non-malignant bone turnover.

In this case and others with high Gleeson grade prostate cancer (i.e. higher risk of spread), it is important to exclude metastases prior to prostatectomy as the surgery alone will not be curative. PSMA PET/CT using the positron-emitting isotope Ga 68 is really influencing the management of patients with high Gleeson grade prostate cancer as is MRI influencing primary detection of cancer and local staging prior to surgery.