How to cite: Crawford ED. PET Tumor Board: Negative PSMA PET Imaging in Biochemical Recurrence with Incidental Detection of Primary Lung Adenocarcinoma. Grand Rounds in Urology. October 2026. Accessed Oct 2026. https://grandroundsinurology.com/pet-tumor-board-negative-psma-pet-imaging-in-biochemical-recurrence-with-incidental-detection-of-primary-lung-adenocarcinoma/
In this presentation, E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, San Diego, California, moderates a multidisciplinary discussion of a case of biochemical recurrence after radical prostatectomy in which repeated prostate-directed positron emission tomography (PET) imaging failed to localize definitive recurrent disease, but surveillance imaging identified an incidental primary lung adenocarcinoma.
The panel of experts includes:
- Wayne G. Brisbane, MD, Assistant Professor of Urology, University of California, Los Angeles, Los Angeles, California
- Sherief H. Gamie, MD, PhD, Chief – Medical Director of the Nuclear/Molecular Imaging and Theranostics Program and a Professor of Radiology, University of California, San Diego, San Diego, California
- Daniel P. Petrylak, MD, Chief of Genitourinary Oncology, Professor of Medicine and Urology, Yale University Cancer Center, New Haven, Connecticut
- Peter Rossi, MD, FABS, FASTRO, Radiation Oncologist, Calaway-Young Cancer Center at Valley View Hospital, Glenwood Springs, Colorado
The discussion highlights the interpretation of negative and equivocal prostate-specific membrane antigen positron emission tomography (PSMA PET) findings, the role of PET and fluorodeoxyglucose (FDG) PET imaging, and management priorities when prostate cancer recurrence overlaps with a suspicious pulmonary lesion.
The case involves a 62-year-old man with Gleason 4+3=7 pT2N0 prostate adenocarcinoma treated with radical prostatectomy in 2017 with negative margins. In 2020, the patient developed biochemical recurrence and received salvage radiation therapy with four months of androgen deprivation therapy. Prostate-specific antigen (PSA) subsequently rose again, with a doubling time of approximately 6 months, reaching 0.69 ng/mL by March 2026, coincident with recovered testosterone levels.
The patient underwent multiple imaging scans. The PSMA scans did not identify definitive recurrent prostate cancer, but PET imaging revealed a suspicious left apical lung lesion.
The panel discusses whether the lesion could represent metastatic prostate cancer lacking PSMA expression versus a second primary malignancy. They debate the value of FDG PET imaging after negative PSMA studies, emphasizing the correlation between PET findings and CT morphology. The group ultimately recommends tissue diagnosis and surgical resection.
The panel concludes that incidental detection of early-stage lung cancer during prostate cancer surveillance imaging may provide a clinically meaningful opportunity for curative intervention while ongoing prostate cancer monitoring continues separately.
ABOUT THE AUTHOR
Researcher-physician E. David Crawford, MD, has devoted his medical career to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States. He is currently a Professor of Urology and Jack A. Vickers Director of Prostate Research at the University of California, San Diego. Dr. Crawford earned his MD from the University of Cincinnati and his postgraduate training, which included an internship and residency in Urology, at the Good Samaritan Hospital in Cincinnati, Ohio. He subsequently completed a fellowship in Genitourinary Cancer at the University of California, Los Angeles. Dr. Crawford is an internationally-recognized expert in benign prostate hypertrophy, urologic cancers, and, in particular, prostate cancer. He has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone-refractory prostate cancer, and other areas of urological infections and malignancies.
Daniel P. Petrylak, MD, is a Professor of Medicine, specializing in Medical Oncology and Urology, and Chief of Genitourinary Oncology at Yale University Cancer Center in New Haven, Connecticut. Dr. Petrylak is an internationally renowned medical oncologist and is considered a pioneer in the research and development of new drugs and treatments to fight cancers of the prostate, bladder, and kidney.
Sherief H. Gamie, MD, PhD, is the Chief and Director of the Nuclear/Molecular Imaging and Theranostics Program and Professor of Radiology at the University of California, San Diego, San Diego, California. Dr. Gamie specializes in nuclear medicine, with expertise in molecular imaging and theranostics, applying precision-targeted radiopharmaceuticals in the diagnosis and treatment of numerous malignancies.
Wayne G. Brisbane, MD, is an Assistant Professor of Urology at the University of California, Los Angeles. Dr. Brisbane received his undergraduate degree from Seattle Pacific University and his medical degree from Loma Linda University School of Medicine. He completed his internship in General Surgery and residency in Urology at the University of Washington. He also served as a Research fellow for the Center for Industrial and Medical Ultrasound. Dr. Brisbane completed his fellowship in Urologic Oncology at the University of California, Los Angeles.
Peter J. Rossi, MD, FABS, FASTRO, is a Radiation Oncologist at Calaway-Young Cancer Center at Valley View in Glenwood Springs, Colorado. Dr. Rossi specializes in prostate cancer, familial prostate cancer, pleuropulmonary blastoma, and posterior fossa tumors. He is an expert in several approaches to cancer treatment, including brachytherapy, Stereotactic Radiosurgery, and Stereotactic Body Radiation Therapy.
