68Ga-PSMA PET/CT With Incidental Finding of COVID-19 in an Asymptomatic Patient

Abstract

A 70-year-old man with prostate adenocarcinoma was diagnosed by transrectal biopsy, with Gleason of 4 + 5 and initial PSA of 225 ng/mL since March 2020. 68Ga-PSMA PET/CT was performed as part of initial staging. The images showed an enlarged prostate with focal PSMA uptake in both lobes. Retroperitoneal and pelvic lymph nodes with moderate uptake of PSMA were shown. Another finding was a moderate PSMA uptake in the both lung parenchymas associated with opacities in CT. The patient denied any symptoms of coronavirus disease and was referred to the emergency department for RT-PCR COVID-19, and the result was positive.

COVID-19 Lung Findings Detected by 68Ga-PSMA PET/CT for Staging Purposes in Patients With Prostate Cancer

“…In Turkey, the first COVID-19 case was confirmed by the Ministry of Health on March 11, 2020, and the first death occurred on March 17, 2020 5 . 68 Ga-PSMA PET/CT findings in COVID-19 have been described in several reports 6–8 …”

Late PET/CT Findings of COVID-19 Pneumonia With 2 Different Radiopharmaceuticals in a Patient

“…8 Incidental COVID-19 pneumonia findings have been reported in very few cases in 68 Ga-PSMA PET/CT, and it can be said that the PSMA uptake is generally lower than FDG. 9 – 11 In the case we presented, we detected that PSMA uptake in residual lung lesions was more intense than FDG 3 months after recovery from COVID-19. Increased uptake of radiopharmaceuticals in the late period of COVID-19 can be explained by capillary penetration caused by local inflammation and relatively elevated activity in the interstitial space.…”

Tracheitis Diagnosed With 68Ga-PSMA PET/CT in a Patient With COVID-19

“…[1][2][3] Cases of COVID-19 pneumonia have been reported incidentally in prostate cancer patients undergoing 68 Ga-PSMA PET/CT imaging. [4][5][6][7][8] However, to our knowledge, there was no report of isolated tracheal PSMA involvement in patients with COVID-19 in the literature before. Tracheal 68 Ga-PSMA uptake seen on PET/CT in asymptomatic patients may raise suspicion for possible COVID-19 disease.…”

“…Although 68 Ga-PSMA is used as an ideal molecular target for both diagnosis and treatment of prostate cancer, PSMA expression is not specific to prostate cells and can be seen in benign processes such as inflammation or infection 1–3 . Cases of COVID-19 pneumonia have been reported incidentally in prostate cancer patients undergoing 68 Ga-PSMA PET/CT imaging 4–8 . However, to our knowledge, there was no report of isolated tracheal PSMA involvement in patients with COVID-19 in the literature before.…”