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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.