Urinary Reflux Mimicking Seminal Vesicle Invasion on 99mTc-HYNIC-PSMA SPECT/CT

A 67-year-old man with lower urinary tract symptoms underwent transurethral resection of the prostate (TURP), revealing prostatic adenocarcinoma. Staging with 99mTc-HYNIC-PSMA SPECT/CT demonstrated focal uptake at the prostate mid-to-base and left seminal vesicle, initially suggesting miT3b disease. However, a subsequent bone scan revealed an identical uptake pattern inferior to the bladder, confirming a urinary artifact rather than true PSMA-avid tumor involvement. This case underscores a recognized pitfall of PSMA imaging following TURP and highlights the value of correlative imaging in preventing false-positive interpretation and ensuring accurate staging.