Abstract
BACKGROUND: This study aimed to perform a head-to-head comparison of the diagnostic efficacy between fluorine-18 prostate-specific membrane antigen-1007 ((18)F-PSMA-1007) and fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) in detecting recurrent and metastatic lesions in patients with prostate cancer (PCa). METHODS: This retrospective study included 87 patients with recurrent and metastatic who underwent both (18)F-FDG and (18)F-PSMA-1007 PET/CT within 14 days. The site-specific detection rates and patient-based diagnostic efficacy were compared. The semiquantitative parameters (SUVmax and lesion-to-background ratios) were analyzed. Correlations between serum prostate-specific antigen (PSA) levels and SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were assessed. The influence of PSA levels on diagnostic performance was also evaluated. RESULTS: The overall detection rate of (18)F-PSMA-1007 PET/CT was significantly higher than that of (18)F-FDG PET/CT [83.9% vs. 51.7%, P < 0.001]. (18)F-PSMA-1007 demonstrated superior detection for prostate bed (34.5% vs. 9.2%, P < 0.001), bone metastases (66.7% vs. 32.2%, P < 0.001), and distant metastases (11.5% vs. 3.4%, P = 0.044), but not for nodal involvement (23.0% vs. 14.9%, P = 0.176). ¹⁸F-PSMA-1007 PET/CT had significantly higher sensitivity (90.74% vs. 57.41%), NPV (54.55% vs. 23.33%) and overall diagnostic accuracy (88.71% vs. 61.29%) than ¹⁸F-FDG; ¹⁸F-FDG had higher specificity (87.50% vs. 75.00%), with both tracers showing high PPV (98.87% and 96.08%, respectively). Among the 41 patients with concordantly positive lesions, (18)F-PSMA-1007 exhibited significantly higher SUVmax, lesion-to-aorta ratio, and lesion-to-muscle ratio (all P < 0.05). (18)F-PSMA-1007 showed superior detection performance in patients with PSA ≤ 2.0 ng/mL (73.47% vs. 38.78%, P < 0.001), with no significant difference in those with PSA > 2.0 ng/mL (84.21% vs. 68.42%, P = 0.105). MTV and TLG measured using (18)F-PSMA-1007 PET/CT showed moderate correlation with PSA levels (r = 0.431, P = 0.005 and r = 0.469, P = 0.002, respectively). CONCLUSIONS: (18)F-PSMA-1007 PET/CT outperformed (18)F-FDG PET/CT in diagnostic efficacy for detecting recurrent and metastatic PCa, with the greatest advantage observed in patients with low PSA levels (≤ 2.0 ng/mL).