Uncommon Penio-Scrotal Metastases of Prostate Cancer Detected on 68 Ga PSMA PET/CT Nikhil Seniaray, DRM,* Ritu Verma, DNB,* Sudhir Khanna, MS, MCh,† Ethel Belho, DRM,* and Dharmender Malik, DNB* Abstract: A 68-year-old man, a known case of carcinoma prostate (Gleason score 4 + 4), status post transurethral resection of prostate cancer and radio- therapy, on hormonal treatment with rising prostate-specific antigen 9.0 ng/mL and penile swelling underwent 68 Ga-PSMA PET/CT scan for metastatic workup and restaging. The study revealed abnormal tracer uptake in the prostatic bed region, the pelvic and inguinal lymph nodes, and metastases to the glans of penis and scrotum. The penile and scrotal lesion was proved to be metastatic adenocarcinoma from prostate on fine-needle aspiration cytology. Key Words: 68 Ga-PSMA PET/CT, prostate cancer (Clin Nucl Med 2019;44: 424–425) REFERENCES 1. Maurer T , Eiber M, Schwaiger M, et al. Current use of PSMA-PET in prostate cancer management. Nat Rev Urol. 2016;13:226–235. 2. Eder M, Schafer M, Bauder-Würst U, et al. Preclinical evaluation of a bi- specific low-molecular heterodimer targeting both PSMA and GRPR for im- proved imaging and therapy of prostate cancer. Prostate. 2014;74:659–668. 3. Afshar-Oromieh A, Malcher A, Eder M, et al. PET imaging with a ( 68 Ga) gallium-labelled PSMA ligand for the diagnosis of prostate cancer: bio- distribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40:486–495. 4. Kabasakal L, Demirci E, Ocak M, et al. Evaluation of PSMA PET/CT imag- ing using 68 Ga-HBED-CC ligand in patients with prostate cancer and the value of early pelvic imaging. Nucl Med Commun. 2015;36:582–587. 5. Afshar-Oromieh A, Avtzi E, Giesel FL, et al. The diagnostic value of PET/CT imaging with the 68 Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42:197–209. 6. Eiber M, Maurer T, Soutvatzoglou M, et al. Evaluation of hybrid 68 Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical pros- tatectomy. J Nucl Med. 2015;56:668–674. 7. Ansari H, Prashant R, Franks A. Prostatic carcinoma metastasis to the penis— an uncommon site. Lancet Oncol. 2003;4:705–706. 8. Dureja S, Thakral P, Pant V, et al. Rare sites of metastases in prostate cancer detected on Ga-68 PSMA PET/CT scan—a case series. Indian J Nucl Med. 2017;32:13–15. 9. Krpina K, Markic D, Spanjol J, et al. Penile metastases of prostate cancer. Acta Clin Croat. 2011;50:431–433. Received for publication December 18, 2018; revision accepted January 25, 2019. From the *Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, and †Urology, Sir Ganga Ram Hospital, New Delhi, India. Conflicts of interest and sources of funding: none declared. Correspondence to: Nikhil Seniaray, DRM, Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, Room 25, Old Rajinder Nagar, New Delhi 110060, India. E-mail: nikhilmamc89@gmail.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/19/4405–0424 DOI: 10.1097/RLU.0000000000002527 INTERESTING IMAGE 424 www.nuclearmed.com Clinical Nuclear Medicine • Volume 44, Number 5, May 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.