Mesothelioma as second primary tumor detected in 68Ga-PSMA PET/CT

Prostate-specific membrane antigen (PSMA) is a glycoprotein highly expressed in prostate cancer cells and increasingly recognized in the neovasculature of various solid tumors. This case report describes a 71-year-old male with prostate adenocarcinoma who underwent 68Ga-PSMA PET/CT for staging. Incidental PSMA uptake was observed in the pleura, which was diagnosed as epithelioid malignant mesothelioma via biopsy. Despite the primary focus on prostate cancer, this highlights the potential of PSMA PET/CT to identify non-prostatic tumors exhibiting PSMA expression. The case underscores the importance of interpreting PSMA PET/CT findings beyond prostate cancer, considering other malignancies such as mesothelioma. Although rare, mesothelioma may demonstrate PSMA uptake, reflecting neovascularization. Recognizing this phenomenon may influence diagnostic and therapeutic strategies, including the potential for radioligand therapy targeting PSMA in non-prostatic tumors. This report emphasizes the expanding role of PSMA PET/CT in oncologic imaging and the need for awareness of incidental findings that could impact patient management.