Matched-Pair Comparison of 68Ga-PSMA-11 PET/CT and 18F-PSMA-1007 PET/CT: Frequency of Pitfalls and Detection Efficacy in Biochemical Recurrence After Radical Prostatectomy

J Nucl Med. 2020 Jan;61(1):51-57. doi: 10.2967/jnumed.119.229187. Epub 2019 Jun 28.


18F-labeled prostate-specific membrane antigen (PSMA)-ligand PET has several principal advantages over 68Ga-PSMA-11. The purpose of this retrospective study was to evaluate the frequency of non-tumor-related uptake and the detection efficacy comparing 68Ga-PSMA-11 PET/CT and 18F-PSMA-1007 PET/CT in recurrent prostate cancer (PC) patients. Methods: The study included 102 patients with biochemically recurrent PC after radical prostatectomy undergoing 18F-PSMA-1007 PET/CT imaging. On the basis of various clinical variables, patients with corresponding 68Ga-PSMA-11 PET/CT scans were matched. All PET/CT scans (n = 204) were reviewed by 1 nuclear medicine physician. First, all PET-positive lesions were noted. Then, lesions suspected of being recurrent PC were differentiated from lesions attributed to a benign origin on the basis of known pitfalls and information from CT. For each region, the SUVmax of the lesion with the highest PSMA-ligand uptake was noted. Detection rates were determined, and SUVmax was compared separately for 68Ga-PSMA-11 and 18F-PSMA-1007. Results: In total, 18F-PSMA-1007 PET and 68Ga-PSMA-11 PET revealed 369 and 178 PSMA-ligand-positive lesions, respectively. 18F-PSMA-1007 PET revealed approximately 5 times more lesions attributed to a benign origin than did 68Ga-PSMA-11 PET (245 vs. 52 lesions, respectively). The benign lesions most frequently observed were ganglia, unspecific lymph node, and bone lesions, at a rate of 43%, 31%, and 24% for 18F-PSMA-1007 PET and 29%, 42%, and 27% for 68Ga-PSMA-11 PET, respectively. The SUVmax of lesions attributed to a benign origin was significantly higher (P < 0.0001) for 18F-PSMA-1007 PET. Further, a similar number of lesions was attributed to recurrent PC (124/369 for 18F-PSMA-1007 PET and 126/178 for 68Ga-PSMA-11 PET). Conclusion: The number of lesions with increased PSMA-ligand uptake attributed to a benign origin is considerably higher for 18F-PSMA-1007 PET than for 68Ga-PSMA-11 PET. This finding indicates the need for sophisticated reader training emphasizing known pitfalls and reporting within the clinical context.

Keywords: PET/CT; PSMA; genitourinary; oncology; pitfalls; prostate cancer.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Gallium Isotopes
  • Gallium Radioisotopes / chemistry*
  • Humans
  • Image Processing, Computer-Assisted
  • Ligands
  • Male
  • Matched-Pair Analysis
  • Membrane Glycoproteins / chemistry*
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Niacinamide / analogs & derivatives*
  • Niacinamide / chemistry
  • Oligopeptides / chemistry*
  • Organometallic Compounds / chemistry*
  • Positron Emission Tomography Computed Tomography*
  • Prostate / pathology
  • Prostatectomy
  • Prostatic Neoplasms / diagnostic imaging*
  • Prostatic Neoplasms / surgery
  • Reproducibility of Results
  • Retrospective Studies
  • Tomography, X-Ray Computed


  • Gallium Isotopes
  • Gallium Radioisotopes
  • Ligands
  • Membrane Glycoproteins
  • Oligopeptides
  • Organometallic Compounds
  • PSMA-1007
  • gallium 68 PSMA-11
  • Niacinamide
  • Gallium-68