Purpose: To evaluate the role of PSMA PET/CT-guided salvage radiotherapy (sRT) in improving long-term biochemical recurrence-free survival (bRFS) in patients with biochemical recurrence (BCR) or PSA persistence (PERS) after radical prostatectomy (RP) for localized prostate cancer. Methods: This single-center retrospective study included 100 patients with BCR or PERS after RP who underwent [⁶⁸Ga]Ga-PSMA-11 PET/CT and sRT according to EAU guidelines. The primary endpoint was bRFS (PSA ≤ 0.2 ng/ml). Results: Sixty-three patients had BCR and 37 had PERS. Fifteen patients had PSA pre-RT < 0.5 ng/ml, while 75 had PSA pre-RT ≥ 0.5 ng/ml. [⁶⁸Ga]Ga-PSMA-11 PET/CT was positive in 52 patients, with BCR patients more frequently exhibiting local recurrence while PERS patients showed more nodal involvement. Patients with PERS received sRT and androgen deprivation therapy (ADT) in 57% of cases. The hazard ratio (HR) of treatment failure for patients with PSA pre-RT ≥ 0.5 ng/ml vs. < 0.5 ng/ml was 2.2 (p < 0.039). With a median follow-up of 59 months, treatment failure occurred in 36% of patients, with no difference between BCR and PERS groups. Among those with treatment failure, 64% were [⁶⁸Ga]Ga-PSMA-11 PET/CT positive at recurrence, and 39% received a new PSMA PET/CT-based RT. All patients were alive at the last analysis. Conclusion: [⁶⁸Ga]Ga-PSMA-11 PET/CT-guided sRT demonstrates significant long-term efficacy in patients with BCR or PERS after RP, leading to durable PSA response and guiding further treatment decisions. Trial registration: 244/2016/O/Oss8 November 2016 retrospectively registered.

Purpose: The uEXPLORER is the first total-body, long-axial field-of-view (LAFOV) PET/CT system available for diagnostic use. The present study aims to assess its clinical impact, with a particular focus on management changes resulting from its use in routine diagnostic workflows. Methods: From June to December 2024, consecutive patients undergoing [18 F]FDG PET/CT for both oncologic and non-oncologic indications were considered for paired acquisitions using short-axial field-of-view (SAFOV) and LAFOV (uEXPLORER) systems. Scans were independently reviewed by three nuclear medicine physicians. Per-patient and per-lesion analyses were performed. Subsequent clinical management decisions were evaluated to determine the impact of LAFOV imaging. Statistical analyses included kappa statistics, Wilcoxon Signed-Rank Test, and Spearman’s correlation coefficient. Results: A total of 124 patients (64% female; median age 65.5 years) were enrolled. Inter-reader agreement was substantial for SAFOV scans (Fleiss’ k = 0.787) and almost perfect for LAFOV scans (Fleiss’ k = 0.853). In per-patient analysis, the two scans were concordant in 85% of cases (Cohen’s k = 0.73). Total lesions identified were 274 on SAFOV PET/CT and 323 on LAFOV PET/CT. Compared to SAFOV, LAFOV imaging detected 52 additional findings in 27 patients ( p < 0.05). The per-lesion agreement was 76% ( p < 0.05). Of the additional lesions identified by LAFOV PET/CT, 42% were confirmed as true positive. LAFOV findings led to changes in clinical management in 15% of patients, including major therapeutic changes in 68% of these cases. Conclusion: LAFOV PET/CT significantly improved lesion detection and influenced clinical decision-making. Further prospective studies are required to validate these findings and fully assess LAFOV systems clinical utility. Trial Registration: Not applicable.

Focal therapy offers a promising approach for treating localized prostate cancer (PC) with minimal invasiveness and potential cost benefits. High-intensity focused ultrasound (HIFU) and brachytherapy (BT) are among these options but lack long-term efficacy data. Patient follow-ups typically use biopsies and multiparametric MRI (mpMRI), which often miss recurrences. PET/CT with PSMA has emerged as a promising tool for detecting residual disease or recurrence post-treatment, offering higher sensitivity and specificity than traditional imaging. We retrospectively reviewed patients who underwent [⁶⁸Ga]Ga-PSMA-11 PET/CT for biochemical recurrence (BCR) after HIFU or brachytherapy from 2016 to 2024. Out of 22 patients, 32% had HIFU and 68% had brachytherapy. The median time from treatment to PET scan was 77 months, with a median PSA level of 3 ng/mL. [⁶⁸Ga]Ga-PSMA-11 PET/CT identified PC recurrence in 63.6% of cases. Of these, 50% showed prostate recurrence, 14% had lymph node involvement, and 28% had metastatic disease. Focal therapies like HIFU and brachytherapy are effective and minimally invasive options for localized PC. [⁶⁸Ga]Ga-PSMA-11 PET/CT is valuable for detecting recurrence or residual disease, enhancing post-treatment surveillance.

PSMA PET has emerged as a crucial imaging modality for staging intermediate- and high-risk prostate cancer (PCa), yet its implementation varies globally. This study aims to assess the diagnostic consequence of omitting pre-operative PSMA PET/CT staging by comparing the radiological features and extent of disease in two cohorts of patients who subsequently developed PSA persistence (> 0.1 ng/mL) following radical prostatectomy (RP). Single-center, retrospective study (October 2019 to May 2025). The patient cohort included individuals who underwent radical prostatectomy and subsequently experienced PSA persistence, defined as a PSA value ≥ 0.1 ng/ml at the first measurement after 4–8 weeks after RP. Patients were divided into two groups: a Staging Cohort who underwent a pre-operative [68Ga]Ga-PSMA-11 PET/CT and a Non-Staging Cohort who did not. All patients received a [68Ga]Ga-PSMA-11PET/CT scan for PSA persistence. Clinical data, including PSA, TNM stage, and ISUP grade, as well as follow-up data were collected. The primary endpoints were the comparison of the overall PSMA PET positivity rate and the extent of both locoregional (N) and distant metastatic (M1) disease between the two cohorts. Secondary analysis included a comparison of baseline pathological characteristics and the evaluation of the potential for a theoretical change in initial patient management. 147 patients with PSA persistence after RP were included and divided into the Staging Cohort (n = 72, 49%) and a Non-Staging Cohort (n = 75, 51%). Baseline data showed the Staging Cohort had a higher proportion of high-grade (ISUP 4/5:72% vs. 45%; p < 0.05 ) and locally advanced (T3/T4: 78% vs. 61%; p < 0.05) disease. The Non-Staging Cohort had a higher rate of positive [68Ga]Ga-PSMA-11 PET/CT scans for persistence (59%) compared to the Staging-Cohort (42%). The Non-Staging Cohort showed a markedly greater extent of disease, with a high proportion of patients (n = 34/75,45%) demonstrating findings consistent with M1 disease (bone or distant lymph nodes). The anatomical distribution of positive lymph node sites also differed: the Staging Cohort showed higher obturator nodes involvement (48% of positive sites), while the Non-Staging Cohort had a significantly higher proportion in common iliac (34%) and external/internal iliac sites. A retrospective evaluation of the Non-Staging Cohort suggested that a pre-operative [68Ga]Ga-PSMA-11 PET/CT would have triggered a theoretical change of management in all 44 positive cases, primarily by suggesting systemic therapy instead of RP for M1 patients. The omission of pre-operative [68Ga]Ga-PSMA-11 PET/CT is associated with a significantly higher incidence of PSMA-positive and extensive disease (locoregional and metastatic) at the time of PSA persistence. This suggests a critical diagnostic gap and potential under-staging in the Non-Staging Cohort, underscoring the vital role of early PSMA PET/CT utilization to optimize initial risk stratification and treatment planning.

Background: Bone scintigraphy using [99mTc]Tc-DPD or [99mTc]Tc-HMDP is a non-invasive cornerstone for diagnosing transthyretin cardiac amyloidosis (ATTR-CA). However, their interchangeability and the clinical relevance of systemic extracardiac uptake (ExtCU) remain poorly defined. Aim: To systematically compare the diagnostic performance and whole-body biodistribution profiles of [99mTc]Tc-DPD and [99mTc]Tc-HMDP in patients with suspected cardiac amyloidosis (CA). Methods: We retrospectively evaluated a multicenter cohort of patients investigated for suspected CA who underwent late planar whole-body scintigraphy and targeted SPECT/CT with either radiotracer as part of their diagnostic workup. Inclusion required a final, confirmed diagnosis of ATTRwt, ATTRv, or AL amyloidosis. Myocardial visual Perugini score (VISUAL_PS) and systemic ExtCU (pulmonary, appendicular muscular, visceral, and miscellaneous) were recorded. Results: The study included 224 patients (DPD: n = 109, comprising 70 ATTRwt, 20 ATTRv, 19 AL; HMDP: n = 115, comprising 90 ATTRwt, 13 ATTRv, 12 AL). In ATTRwt, the DPD cohort presented predominantly with Perugini Grade 2 (76%), whereas the HMDP cohort skewed toward Grade 3 (72%, p < 0.001). DPD was significantly associated with appendicular muscular uptake (ATTRwt: 84% vs. 38%, p < 0.001), creating a competitive “soft-tissue sink effect”. Conversely, HMDP demonstrated a unique predilection for pulmonary retention (ATTRwt: 68% vs. 46%, p = 0.008; ATTRv: 61% vs. 10%, p = 0.006). Visceral uptake was rare in ATTR but was a robust negative predictor strongly favoring AL amyloidosis (OR 0.016, p < 0.001). Conclusions: [99mTc]Tc-DPD and [99mTc]Tc-HMDP possess distinct biodistribution profiles precluding direct interchangeability. HMDP maximizes myocardial contrast, whereas DPD provides a superior representation of the systemic musculoskeletal amyloid burden. Nuclear medicine physicians must adopt tracer-specific interpretive approaches to optimize non-invasive phenotyping. Trial registration: not applicable.