Stereotactic Body Radiation Therapy (SBRT)-Induced 68 Ga-PSMA PET Bone Flare.
Valentina Marulanda-Corzo, Preeti Kakkar, Arman Sharbatdaran et al.
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Case in brief
A 65-year-old man with oligometastatic prostate cancer underwent radical prostatectomy and SBRT to a right pubic bone metastasis. Four weeks later, PSMA PET showed greater extent and intensity of uptake at the treated site, although PSA had fallen 92% (8.5 to 0.7 ng/mL) and no new lesions were seen. Subsequent imaging showed resolution of uptake at that site, consistent with bone flare, but also multiple new bone metastases; PSA had risen to 2.8 ng/mL, indicating disease progression.
What made this case unusual
The treated bone lesion showed increased PSMA uptake soon after SBRT despite a marked PSA decline and no new lesions, then resolved on later imaging. The authors describe this as SBRT-induced bone flare.
Diagnostic / clinical pearl
Increased uptake at a recently irradiated bone metastasis on early posttreatment PSMA PET may reflect bone flare; interpret it alongside PSA and subsequent imaging.