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Ominous-appearing serosal findings on PSMA imaging might belie indolent clinical course

Understanding of metastatic prostate cancer is mainly defined by macroscopic findings, but prostate-specific membrane antigen (PSMA) PET has increased sensitivity. PSMA+ serosal-based findings on the surface of the liver and other organs might not have the same implications when seen on PSMA PET versus conventional imaging. Awareness of this phenomenon is important in assessing whether treatment escalation is truly required.

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Fig. 1: PSMA PET–CT imaging of a patient with biochemically recurrent disease with three PSMA+ lesions on the liver serosal surface.

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Acknowledgements

The contributions of the NIH author(s) were made as part of their official duties as NIH federal employees, are in compliance with agency policy requirements, and are considered Works of the United States Government. However, the findings and conclusions presented in this paper are those of the author(s) and do not necessarily reflect the views of the NIH or the US Department of Health and Human Services.

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Correspondence to Ravi A. Madan.

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Abel, M.L., Mena, E., Lindenberg, L. et al. Ominous-appearing serosal findings on PSMA imaging might belie indolent clinical course. Nat Rev Urol (2025). https://doi.org/10.1038/s41585-025-01083-x

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