68Ga-PSMA PET/CT After Open Transvesical Prostatectomy: The Diagnostic Challenge of Postoperative Urinary Reflux

We report a case of a 68-year-old man with incidentally discovered prostate adenocarcinoma following open transvesical prostatectomy for presumed benign prostatic hyperplasia. Initial ⁶⁸Ga-PSMA PET/CT demonstrated focal uptake in the left seminal vesicle, raising concern for seminal-vesicle invasion. Delayed imaging showed persistent but decreasing activity paralleling urinary clearance, and multiparametric MRI confirmed postoperative changes without evidence of tumor extension. The finding was ultimately attributed to urinary reflux into the seminal vesicle, a potential false-positive pitfall in patients with prior outlet-reconstructive surgery. Awareness of this phenomenon and multimodality correlation are essential to avoid misinterpretation and inappropriate management.