Isolated Diffuse Lung Metastasis from Prostate Cancer Detected on [99mTc]Tc-PSMA SPECT/CT

Shakeri, Sara; Saber Tanhga, Amin; Farahmandfar, Fatemeh; Sadeghi, Ramin; Samadi, Mohammad Hadi

doi:10.22038/aojnmb.2026.96725.1728

Isolated Diffuse Lung Metastasis from Prostate Cancer Detected on [99mTc]Tc-PSMA SPECT/CT

Articles in Press

Document Type : Case report

Authors

Sara Shakeri ¹

Amin Saber Tanhga ²

Fatemeh Farahmandfar ³

Ramin Sadeghi ²

Mohammad Hadi Samadi ²

¹ Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran

² Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

³ Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

10.22038/aojnmb.2026.96725.1728

Abstract

A 67-year-old man presented with lower urinary tract symptoms and a markedly elevated prostate-specific antigen (PSA) level of 170 ng/mL. Contrast-enhanced CT demonstrated no regional lymphadenopathy, while conventional skeletal assessment with [99mTc]Tc-MDP bone scintigraphy showed no evidence of osseous metastases. Subsequent whole-body [99mTc]Tc-PSMA scintigraphy unexpectedly revealed diffuse, heterogeneous radiotracer uptake throughout both lungs. Hybrid SPECT/CT localized this uptake to numerous randomly distributed bilateral pulmonary nodules, predominantly in the basal segments, without abnormal uptake in lymph nodes or other visceral organs and with only mild diffuse uptake in the prostate gland, corresponding to a PRIMARY score of 1 and molecular imaging stage miN0M1c. Isolated pulmonary metastases from prostate cancer are rare, particularly in the absence of bone or nodal involvement. This case demonstrates the ability of technetium-labeled PSMA imaging to identify an unusual metastatic pattern, emphasizing its complementary value for accurate staging, recognition of atypical visceral disease, and optimization of subsequent clinical management.

Keywords

Prostate adenocarcinoma

Visceral metastasis

Molecular imaging

Theranostics

Pulmonary metastasis

Subjects