Comparative study of the most commonly-used radiopharmaceuticals for PSMA prostate PET/CT imaging

Prostate cancer (PCa) is one of the most common malignancies and cause of cancer death in men. Prostate-specific antigen (PSA) is the most used biomarker in the detection of early PCa. Lately, scientists have been using prostate-specific membrane antigen (PSMA), a glycol-protein that is over-expressed in PCa cells in positron emission tomography/ computed tomography (PET/CT) scans to detect PCa. Gallium-68-PSMA radiotracers, such as ⁶⁸Ga-PSMA-11, ⁶⁸Ga-PSMA-617 and ⁶⁸Ga-PSMA I&T, were firstly introduced in 2011 and fluorine-18-PSMA based radiotracers followed with ¹⁸F-PSMA-1007,N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]- 4-¹⁸F-fluorobenzyl-L-cysteine(¹⁸F-DCFBC) and 2-(3-(1-carboxy-5-[(6-[¹⁸F]fluoro-pyridine-3-carbonyl)-amino]-pentyl)-ureido)- pentanedioic acid (¹⁸F-DCFPyL), also known as PYLARIFY, being the most used and showed superior results compared to conventional imaging techniques. Differences depending on half-life, clearance and normal organ uptake are being detected through research to determine which of the radiotracers, is the most suitable for each patient. Two of them, ⁶⁸Ga-PSMA-11 and PLYRIFY, have already been approved by the Food and Drug Administration (FDA). The future of hybrid imaging for PCa is very promising if we consider the advantages of PSMA radiotracers compared to non-PSMA radioligands.