A 65-year-old man with oligometastatic prostate cancer underwent radical prostatectomy and stereotactic body radiation therapy (SBRT) to a right pubic bone metastasis. Four weeks after SBRT, PSMA PET showed increased extent and intensity of uptake at the treated site, despite a 92% PSA decline (8. 5 to 0.7 ng/mL) and no new lesions. Later imaging confirmed resolution of uptake, consistent with bone flare, but revealed multiple new osseous metastases and rising PSA (2.8 ng/mL), indicating progression. To our knowledge, this is the first reported case of SBRT-induced bone flare, highlighting the need for cautious interpretation of early posttreatment PSMA PET.
Clinical nuclear medicine. 2026 Mar 31 [Epub ahead of print]
Valentina Marulanda-Corzo, Preeti Kakkar, Arman Sharbatdaran, Cora N Sternberg, Sandra Huicochea-Castellanos
Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine., Englander Institute for Precision Medicine, Weill Cornell Medicine, Hematology and Oncology, New York-Presbyterian Hospital, New York, NY.