Comparing PSMA-PET agents: What urologists should know

In this video, Chad R. Ritch, MD, MBA, FACS, discusses findings from a multicenter comparison of piflufolastat and flotufolastat PET imaging in patients with biochemical recurrence of prostate cancer¹ and the evidence needed to establish meaningful differences between imaging agents. Ritch is chair of the Division of Urology for the Cleveland Clinic Florida Market.

Ritch highlights how differences in tracer uptake in the pelvic region and bladder may influence clinicians’ ability to evaluate the prostate bed, particularly when determining whether suspicious findings represent recurrent disease or physiologic tracer activity. Although the analysis suggested differences in detection rates between the 2 agents,¹ he emphasizes that the findings were not confirmed by biopsy. He also notes that the study did not establish whether the differences in detection influenced treatment decisions or improved patient outcomes.

Looking ahead, Ritch identifies histopathologic confirmation and long-term clinical outcomes as important measures for evaluating differences between PSMA-PET imaging agents. He explains that higher detection rates would be more clinically meaningful if they corresponded with confirmed cancer findings. Additionally, demonstrating that earlier identification of recurrence or metastases leads to improvements in overall survival or prostate cancer–specific survival would help establish the clinical value of one imaging agent over another.

As Ritch explains, imaging performance alone does not necessarily establish clinical benefit: “If at the end of the day it doesn't improve the patient's oncologic outcome, then detecting these things earlier or finding these things may not necessarily be clinically meaningful.”

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REFERENCE
1. Nordquist LT, Andrews JR, Kuo PH, et al. An intra-patient contemporaneous comparison of ¹⁸F-piflufolastat and ¹⁸F-flotufolastat urinary radioactivity and pelvic region detection rates in men with low PSA biochemical recurrence of prostate cancer after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2026;53(6):3529-3541. doi:10.1007/s00259-025-07732-y