Fig. 6.

⁶⁸Ga-PSMA-11 positron emission tomography/magnetic resonance imaging (⁶⁸Ga-PSMA-11 PET/MRI) depicts lesions missed by choline PET. (A) Staging prostate MRI (top T2-weighted fast recovery fast spin-echo sequence, middle diffusion-weighted sequence, and bottom apparent diffusion coefficient) and bone scan of a 64-year-old patient with a T1c, Gleason score 4 + 4 = 8 tumor, and initial PSA level of 14.3 ng/ml show a PIRADS 4 lesion without suspicious pelvic lymph nodes nor bone metastasis. The patient underwent radical prostatectomy and had a persistent PSA value of 5.27 ng/ml 7 weeks after the surgery. (B) Subsequent choline PET showed a single suspicious rip lesion that was then treated with radiotherapy causing only a slightly drop of the PSA to 4.2 ng/ml with a subsequent rise to 7.15 ng/ml. (C) Following the PSA rise, ⁶⁸Ga-PSMA-11 PET/CT was performed and showed lymph node metastasis and local recurrence