FIGURE 4.

Metachronous oligometastasis in 73-y-old man with BCR (PSA, 4.0 ng/mL) after prostatectomy and adjuvant radiation therapy for prostate cancer (Gleason score, 9; International Society of Urologic Pathologists grade, 5). (A) Baseline ⁶⁸Ga-PSMA PET/CT shows single osseous lesion at T8 vertebral body (arrow in A, dotted circles in A and B). (B) Follow-up ⁶⁸Ga-PSMA PET/CT obtained 8 mo after metastasis-directed SABR of T8 lesion shows partial radiographic local response of lesion but development of new lesions elsewhere in spine despite biochemical response, with overall PSA decline to 2.28 ng/mL. Arrows in B show new metastatic lesions in spine. Shown are maximum-intensity projections (first and fourth panels) and sagittal PET/CT images (second and third panels). SBRT = stereotactic body radiation therapy. (Reprinted with permission of (35)).