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000301724 1001_ $$00000-0002-3634-9541$$aMahmoud, Osama$$b0
000301724 245__ $$aMultitracer comparison of gold standard PSMA-PET/CT with 68Ga-FAPI and 18F-FDG in high-risk prostate cancer: a proof-of-concept study.
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000301724 500__ $$a2025 Nov;52(13):4860-4869
000301724 520__ $$aThe aim of this study was to, evaluate the diagnostic accuracy of [⁶⁸Ga]Ga-FAPI-46 positron emission tomography (PET)/computed tomography (CT) in high-risk prostate cancer (PC) compared to [¹⁸F]PSMA / [⁶⁸Ga]Ga- PSMA- and [¹⁸F]FDG- PET/CT as well as multiparametric magnetic resonance imaging (MRI).Ten patients with high-risk PC (PSA > 20 ng/mL, Gleason score > 7, or > T2c) underwent PET/CT imaging using [⁶⁸Ga]Ga-FAPI-46, [¹⁸F]F-/[⁶⁸Ga]Ga-PSMA and [¹⁸F]FDG before radical prostatectomy (RP). The maximum standardized uptake values (SUVmax) were measured for the entire prostate and individual prostate sextants. Diagnostic accuracy was assessed per patient and per segment by correlating imaging findings with final histopathologic results. Immunohistochemical analysis of PSMA and FAP expression was performed on the index tumor lesion.Histopathologic analysis confirmed pT2c and pT3 prostate adenocarcinoma in 4 (40%) and 6 (60%) patients, respectively. One patient (10%) had regional lymph node metastasis (pN1). The International Society of Urological Pathology (ISUP) grade groups (GGs) were 2 (60%), 3 (20%), and 5 (20%). Overall, 46 of 60 prostate sextants were histologically positive for PC. While PSMA expression was detected in all patients, FAP expression was observed in 5 of 9 cases (55.5%). Per-patient and per-segment analyses demonstrated that [⁶⁸Ga]Ga-FAPI-46 and [¹⁸F]F-/[⁶⁸Ga]Ga-PSMA had comparable diagnostic accuracy and outperformed [¹⁸F]FDG. The mean (SD) SUVmax of the entire prostate was highest for PSMA PET/CT at 13.1 (7), followed by FAPI at 7.6 (5.5) and FDG at 5.4 (3.5) (p = 0.015). Among patients in the FAPI subgroup, those with ISUP GG 3-5 exhibited greater FAP expression and radiotracer uptake compared to ISUP GG 2 cases. In the two high-grade patients, [⁶⁸Ga]Ga-FAPI-46 demonstrated greater tumor uptake than [¹⁸F]PSMA / [⁶⁸Ga]Ga-PSMA PET/CT. Notably, MRI demonstrated higher diagnostic accuracy and superior local staging compared to all radiotracers evaluated.FAP expression was detected in a subset of high-risk PC patients, particularly in those with higher-grade disease. This proof-of-concept study may suggest a role for [⁶⁸Ga]Ga-FAPI-46 PET/CT in primary PC with low PSMA avidity, but further research is warranted to define its clinical application.
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000301724 650_7 $$2Other$$aFibroblast activation protein
000301724 650_7 $$2Other$$aFluorodeoxyglucose F18
000301724 650_7 $$2Other$$aPositron emission tomography
000301724 650_7 $$2Other$$aProstate neoplasms
000301724 650_7 $$2Other$$aProstate-specific membrane antigen
000301724 7001_ $$aPüllen, Lukas$$b1
000301724 7001_ $$aUmutlu, Lale$$b2
000301724 7001_ $$aSzarvas, Tibor$$b3
000301724 7001_ $$0P:(DE-HGF)0$$aFendler, Wolfgang P$$b4
000301724 7001_ $$aTing, Saskia$$b5
000301724 7001_ $$aReis, Henning$$b6
000301724 7001_ $$aBayer, Henning$$b7
000301724 7001_ $$0P:(DE-HGF)0$$aHerrmann, Ken$$b8
000301724 7001_ $$aHadaschik, Boris A$$b9
000301724 7001_ $$aAl-Nader, Mulham$$b10
000301724 7001_ $$0P:(DE-HGF)0$$aBerliner, Christoph$$b11
000301724 773__ $$0PERI:(DE-600)2098375-X$$a10.1007/s00259-025-07352-6$$n13$$p4860-4869$$tEuropean journal of nuclear medicine and molecular imaging$$v52$$x1619-7070$$y2025
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