ArticleEuropean journal of nuclear medicine and molecular imaging2026
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Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
purposeTo investigate the potential of a second 18F-flotufolastat positron emission tomography (PET) scan in patients with suspected biochemical recurrence (BCR) of prostate cancer (PCa) who had a previous negative 18F-flotufolastat PET, and to identify prostate-specific antigen (PSA) parameters influencing detection efficacy.
methodsOur retrospective analysis included data from patients who underwent second 18F-flotufolastat PET between 2019 and 2024, following negative 18F-flotufolastat PET for suspected BCR of PCa (PSA ≥ 0.2 ng/mL) after radical prostatectomy. Two board-certified experts classified 18F-flotufolastat-avid lesions per miTNM categories. Patient-level detection rates were stratified by: pre-PET scan PSA; absolute/relative difference in PSA (ΔPSA) between negative first and second PET; PSA velocity (PSAvel); PSA doubling time (PSAdt). Receiver operating characteristic (ROC) curve analyses were performed.
resultsOf 101 patients (median age = 70 years; median PSA = 0.79 ng/mL), 58 (57%) had a positive second 18F-flotufolastat scan. Detection rates increased with PSA level, ΔPSA, PSAvel, and PSAdt. Differences in PSA level, ΔPSA, PSAvel, and PSAdt between groups with/without suspicious 18F-flotufolastat uptake were statistically significant (p < 0.05). Cut-offs for statistically optimal trade-off between negative and positive second PET (ROC analyses) were: PSA level > 0.82 ng/mL; absolute ΔPSA > 0.50 ng/mL; relative ΔPSA > + 100%; PSAvel > 0.30 ng/mL/y; PSAdt ≤ 17 months.
conclusionIn over half of patients presenting with BCR after radical prostatectomy and an initial negative 18F-flotufolastat PET, second 18F-flotufolastat PET identified recurrent lesions. PSA level at time of second PET, absolute/relative ΔPSA, PSAvel, and PSAdt influenced scan positivity.
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