Intense Incidental F-18 DOPA Uptake in Low-grade Prostate Adenocarcinoma

F-18 DOPA PET/CT is well established in the evaluation of neuroendocrine tumors and pheochromocytoma/paraganglioma. Prostatic uptake is not part of its usual physiological biodistribution, and its significance in conventional prostate adenocarcinoma remains unclear. We report intense incidental prostatic F-18 DOPA uptake in a 60-year-old man undergoing evaluation for persistently elevated normetanephrines. PET/CT showed 2 highly avid foci in the posterior-inferior prostate. Multiparametric MRI was not suspicious, but biopsy revealed acinar adenocarcinoma, Gleason score 3+3, ISUP grade 1, without neuroendocrine marker expression. This finding represents a potential diagnostic pitfall and supports cautious interpretation of focal pelvic F-18 DOPA uptake.