Prostate Adenocarcinoma Recurrence in the Vas Deferens Unveiled by 99mTc-PSMA SPECT/CT Imaging

We present a case involving a 77-year-old man with prostate cancer who underwent radical prostatectomy with negative surgical margins. After 10 years without follow-up, his serum prostate-specific antigen level increased to 2.76 ng/mL, suggesting disease recurrence. Due to limited access to 68 Ga-PSMA PET/CT, a 99m Tc-HYNIC-PSMA SPECT/CT was conducted, which identified PSMA uptake in the bilateral vas deferens, a rare site for recurrence. While recurrence in the vas deferens has been previously reported using 68 Ga-PSMA PET/CT or PET/MR, this novel experience with 99m Tc-PSMA SPECT/CT highlights its potential utility in detecting such recurrences. This is particularly relevant in low-income countries where access to PET/CT may be limited.