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@ARTICLE{Mahmoud:301724,
      author       = {O. Mahmoud and L. Püllen and L. Umutlu and T. Szarvas and
                      W. P. Fendler$^*$ and S. Ting and H. Reis and H. Bayer and
                      K. Herrmann$^*$ and B. A. Hadaschik and M. Al-Nader and C.
                      Berliner$^*$},
      title        = {{M}ultitracer comparison of gold standard {PSMA}-{PET}/{CT}
                      with 68{G}a-{FAPI} and 18{F}-{FDG} in high-risk prostate
                      cancer: a proof-of-concept study.},
      journal      = {European journal of nuclear medicine and molecular imaging},
      volume       = {nn},
      issn         = {1619-7070},
      address      = {Heidelberg [u.a.]},
      publisher    = {Springer-Verl.},
      reportid     = {DKFZ-2025-01116},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {The 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.},
      keywords     = {Fibroblast activation protein (Other) / Fluorodeoxyglucose
                      F18 (Other) / Positron emission tomography (Other) /
                      Prostate neoplasms (Other) / Prostate-specific membrane
                      antigen (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40423777},
      doi          = {10.1007/s00259-025-07352-6},
      url          = {https://inrepo02.dkfz.de/record/301724},
}