Unexpected 18F-PSMA-1007 Uptake in a Colonic Diverticulum

A 68-year-old man with rising PSA (0.363 ng/mL) 6 years post-prostatectomy underwent 18 F-PSMA-1007 PET/CT. The scan revealed rib metastasis and an unexpected PSMA-avid focus in the ascending colon. Previous 68 Ga-PSMA and subsequent 18 F-FDG PET both showed no abnormal uptake in the ascending colon area. Colonoscopy confirmed an ascending colon diverticulum. This rare case demonstrates intense 18 F-PSMA-1007 uptake in a colonic diverticulum, likely attributable to PSMA expression by neovascular endothelium or inflammatory cells. Clinicians should consider colonic diverticulum in the differential diagnosis of PSMA-avid colonic lesions to prevent misdiagnosis.