PSMA PET-CT has revolutionized prostate cancer imaging due to its high sensitivity, yet it is prone to false-positive findings in benign lesions such as vertebral hemangiomas [1, 2]. Atypical hemangiomas may mimic metastases, leading to unnecessary interventions. In this case, fluciclovine PET-CT confirmed the benign nature of the PSMA-expressing lesion. Studies have shown that fluciclovine PET offers superior specificity in differentiating malignant prostate lesions from benign conditions [5, 6]. Its targeted mechanism—focusing on amino acid transporters overexpressed in prostate cancer cells—avoids uptake in benign lesions.

When combined with PSMA PET, fluciclovine PET enhances diagnostic accuracy, reducing misdiagnosis, unnecessary biopsies, and healthcare costs. By integrating these modalities, clinicians can optimize staging and treatment planning, ensuring appropriate care for prostate cancer patients with ambiguous PSMA PET findings.

Whenever PSMA PET results are inconclusive, fluciclovine PET-CT can serve as a complementary modality. Its specificity in distinguishing benign vertebral hemangiomas from malignant metastases minimizes diagnostic uncertainty, unnecessary interventions, and healthcare costs. When PSMA PET findings are equivocal, fluciclovine PET-CT can be considered to improve prostate cancer staging accuracy.