Study compares PSMA-PET radiopharmaceuticals in prostate cancer recurrence

In this video, Jack R. Andrews, MD, discusses findings from the BED-PSMA-411 trial (NCT06604442) comparing the detection rates and urinary excretion of 2 prostate-specific membrane antigen (PSMA)–targeted PET radiopharmaceuticals in patients with biochemical recurrence of prostate cancer post-prostatectomy. Andrews is a urologic oncologist at Mayo Clinic in Phoenix, Arizona.

BED-PSMA-411 was an intra-patient head-to-head study comparing ¹⁸F-flotufolastat (Posluma) and ¹⁸F-piflufolastat (Pylarify) in this setting. The study enrolled 55 men with biochemical recurrence after radical prostatectomy and prostate-specific antigen (PSA) levels of 0.5 ng/mL or lower. According to Andrews, previously reported findings showed that ¹⁸F-flotufolastat had lower urinary excretion than ¹⁸F-piflufolastat, potentially improving visualization of the prostate bed and vesicourethral anastomosis, where urinary tracer activity can obscure local recurrence.

At the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting, investigators reported detection rates stratified by baseline PSA, time since radical prostatectomy, initial disease stage, and International Society of Urological Pathology Grade Group.¹ Overall patient-level detection rates were 45% with ¹⁸F-flotufolastat compared with 27% with ¹⁸F-piflufolastat. Detection rates were numerically higher with ¹⁸F-flotufolastat across all evaluated clinical subgroups, although the small sample size limited definitive conclusions about differences within individual categories. Andrews discusses how these findings may inform PSMA-PET tracer selection for men with biochemical recurrence and low PSA levels.

REFERENCE

1. Andrews JR, Sykes J, Cohen T. Impact of Clinical Factors on 18 F-Piflufolastat and 18 F-Flotufolastat Detection Rates in Patients with Recurrent Prostate Cancer Post-Prostatectomy: Results from an Intra-Patient Head-to-Head Study. Presented at: 2026 American Society for Radiation Oncology Annual Meeting. September 26 -30, 2026. Boston, Massachusetts. Poster 3220