18 F-fluciclovine PET Imaging of Non-PSMA Expressing High-risk Primary Prostate Cancer.

Clin Nucl MedAug 31, 2026 (epub)
Case ReportOncology (Medical)Radiology (Diagnostic)

Ismaheel O Lawal, Lara R Harik, Akshay S Bedmutha et al.

✦ AI-curated · Sources linked

Case in brief

A 67-year-old man with rising PSA and a palpable prostate lesion had a large PI-RADS 5 lesion on MRI. Biopsy showed high-grade prostate cancer (Gleason score 9 [4+5], grade group 5). For initial staging, 18F-DCFPyL PET/CT showed no significant PSMA avidity in the primary lesion. Off-label 18F-fluciclovine PET demonstrated intense uptake. Immunohistochemistry confirmed high amino acid transporter expression and low PSMA expression. The report describes 18F-fluciclovine PET/CT as a potential off-label staging alternative when a primary prostate cancer lacks significant PSMA expression.

What made this case unusual

The high-grade primary tumour was not significantly PSMA-avid but showed intense 18F-fluciclovine uptake, with immunohistochemistry supporting high amino acid transporter and low PSMA expression.

Diagnostic / clinical pearl

When a primary prostate cancer is not significantly PSMA-avid, 18F-fluciclovine PET/CT may provide an alternative imaging approach; in this case, immunohistochemistry supported the differing tracer uptake.

Source

PubMed · PMID 42578557

Published in Clin Nucl Med. This summary was written by xxcode from the publication's abstract and metadata. It is not peer reviewed and is not a substitute for the original article. For clinical decisions, review the original publication.

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