We present the case of a 64-year-old man with prostate adenocarcinoma, Gleason score 7, after radical prostatectomy and adjuvant radiotherapy in 2015. Because of high risk and perineural invasion, hormonotherapy was indicated. PSA levels began to rise, and at PSA level of 0.9 ng/mL, he was referred for 68Ga-PSMAPET/CT. It showed focal uptake in the right femur and diffuse tracer accumulation in bone marrow. The patient was previously diagnosed with macrocytic anemia. He underwent bone marrow biopsy. Based on clinical, laboratory, and histopathology results, myelodysplastic fibrosis was diagnosed. Diffuse uptake of 68Ga-PSMA was the sign of the bone marrow stimulation.
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