Intense PSMA Uptake in a Vertebral Hemangioma Mimicking a Solitary Bone Metastasis in the Primary Staging of Prostate Cancer via 68Ga-PSMA PET/CT

A 78-year-old man with newly diagnosed high-risk prostate cancer underwent 68Ga-PSMA PET/CT for primary staging. This showed a single, very intense PSMA uptake in the vertebral body of Th2, without discrete morphological changes on low-dose CT. Thus, the patient was considered oligometastatic and underwent MRI of the spine for stereotactic radiotherapy planning. MRI demonstrated an atypical hemangioma in Th2. A bone algorithm CT scan confirmed the MRI findings. The treatment was changed, and the patient underwent a prostatectomy with no concomitant therapy. At three and six months after the prostatectomy, the patient had an unmeasurable PSA level, confirming the benign etiology of the lesion.