Strong PSMA Expression by a Pituitary Macroadenoma on PSMA PET/CT

An 81-year-old man was found to have an elevated PSA, prompting a prostate biopsy that revealed Gleason grade 7 (3+4) prostate cancer. For staging purposes, an 18F-DCFPyL PSMA PET/CT was performed, which demonstrated focal uptake in the pituitary region corresponding to a suprasellar mass. Subsequent pituitary MRI confirmed the presence of a pituitary macroadenoma. The expanding global use of PSMA PET has increasingly revealed PSMA ligand uptake in a variety of non-prostatic benign and malignant conditions, creating false positive results. Our case highlights that pituitary macroadenoma may have strong PSMA expression and should be recognized as a potential imaging pitfall.