Comprehensive Approach to Prostate Cancer Metastasis Mimics at Prostate-Specific Membrane Antigen PET/CT.

Prostate-specific membrane antigen (PSMA) PET has transformed prostate cancer (PCa) imaging. Nevertheless, major diagnostic pitfalls remain as PSMA expression is not exclusive to PCa and may also occur in physiologic tissues and a range of benign and malignant conditions. These conditions may mimic PCa metastases, leading to potential misinterpretation. Accurate risk assessment of suspected lesions using PSMA PET/CT requires the integration of uptake intensity, lesion location, corresponding anatomic imaging findings, and clinical context. The authors outline common and diagnostically challenging mimics of PCa metastases seen at PSMA PET/CT and present a structured risk-assessment approach that incorporates current standardized scoring systems. ©RSNA, 2026 Supplemental material is available for this article.