From the Research
Yes, old bone fractures can express significant Prostate-Specific Membrane Antigen (PSMA), which is an important consideration in medical imaging interpretation. This phenomenon occurs because PSMA is not exclusively expressed in prostate tissue but can also be found in areas of active bone remodeling and healing, as discussed in the context of bone remodeling and healing processes 1, 2, 3. When a bone fracture occurs, even years prior, the repair process involves increased vascularity and osteoblastic activity that can persist long after the fracture has clinically healed. These areas of bone remodeling can demonstrate PSMA uptake on PET/CT scans, potentially mimicking metastatic prostate cancer lesions. The mechanism behind this uptake relates to PSMA expression in newly formed blood vessels (neovasculature) that develop during the healing process.
Key points to consider include:
- The process of bone remodeling, which involves the replacement of old and damaged bone with new bone through a sequence of cellular events, can lead to PSMA expression in areas of active bone remodeling and healing 1.
- The intensity of PSMA expression in old fractures can vary but may be quite significant in some cases, creating false-positive findings that complicate interpretation.
- Radiologists and nuclear medicine physicians should always correlate PSMA-PET findings with the patient's trauma history and conventional imaging to avoid misdiagnosis, particularly when evaluating men with prostate cancer for potential bone metastases.
- Understanding the mechanisms of bone healing and the factors that affect them, such as inflammation, blood supply, biomechanical instability, immunosuppression, and smoking, can provide valuable insights into the underlying principles of bony fixation and improve patient care 2.
- The impact of aging on bone remodeling homeostasis, including the mechanism of ion channels on bone remodeling, should also be considered in the context of PSMA expression in old bone fractures 3.