[¹⁸F] PSMA PET-CT and [¹⁸F] Choline PET-CT in the Diagnosis of High-Risk Localized Prostate Cancer: Comparation of...

To compare choline PET-CT and PSMA PET-CT in a cohort of patients with high-risk localized prostate cancer, assessing the diagnostic capacity of both tests. whose therapeutic approach could be modified based on the results.

An observational study was conducted in 116 patients with high-risk prostate cancer between January 2021 and January 2024. All patients underwent sequential choline and PSMA PET-CT scans. Clinical and pathological data were collected, and extraprostatic disease and SUVmax values in these locations were evaluated.

The mean age was 68.9 years (SD 7.8) and the median PSA at diagnosis was 14.6 ng/mL. The most frequent ISUP grade was 2 (28.5%). The mean interval between the two tests was 19 days. All patients had detectable intraprostatic tumor activity with both techniques. In 28.6% of patients with negative choline PET-CT, PSMA PET-CT detected extraprostatic disease. In the subgroup undergoing radical prostatectomy, PSMA PET-CT positivity was significantly associated with the presence of positive surgical margins (p < 0.05). PSMA PET-CT showed a significant association with ISUP ≥ 3 (OR 2.42; p < 0.05). SUVmax in extraprostatic lesions was higher in patients with ISUP ≥ 3 in both choline and PSMA PET-CT, being stronger with PSMA PET-CT (OR 22.67 vs. 3.26).

PSMA PET-CT offers superior diagnostic performance to choline PET-CT in patients with high-risk prostate cancer which has a clinical impact on therapeutic decision-making.