When PSMA is not enough: the diagnostic blind spots of PSMA PET/CT and the added value of [¹⁸F]FDG in…

Cohort studyCancer imaging : the official publication of the International Cancer Imaging Society· Jul 2026

When PSMA is not enough: the diagnostic blind spots of PSMA PET/CT and the added value of [¹⁸F]FDG in high-risk prostate cancer: dual-tracer cohort study.

Efrah Ahmed Ibrahim, Eray Alper

Oncologic ImagingCohort studyDiagnosisQ1IF 4.9

Adding FDG PET/CT changed management in over half of high-risk prostate cancer patients

When PSMA is not enough: the diagnostic blind spots of PSMA PET/CT and the added value of [¹⁸F]FDG in high-risk prostate cancer: dual-tracer cohort study.

Efrah Ahmed Ibrahim, Eray Alper

Cancer imaging · Jul 2026 · Q1 in Radiology

Purpose

This study evaluated the additional diagnostic yield and direct clinical impact of incorporating [¹⁸F]FDG PET/CT into a systematic, indication-driven dual-tracer protocol in high-risk prostate cancer patients.

Methods

In this retrospective, STROBE-compliant, single-center cohort study, 82 patients with histologically confirmed prostate cancer who underwent both [⁶⁸Ga]Ga-PSMA-11 and [¹⁸F]FDG PET/CT were analyzed.

n = 82 patients

Results

FDG PET/CT changed treatment decisions in more than half of patients

70.7%

PSMA detection

25.6%

FDG detection

More results

The most impactful contributions were histopathologically confirmed second primary malignancies detection (30.5%, predominantly lung and colorectal adenocarcinomas) and identification of PSMA-negative/FDG-positive discordant disease signaling dedifferentiation.

More results

No significant correlation was found between PSMA and FDG SUVmax values (Spearman rho = 0.149, p = 0.422), underscoring their biologically distinct and complementary targets.

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Conclusion · 1 of 2

[¹⁸F]FDG PET/CT is not a redundant adjunct to PSMA imaging; it fills a critical diagnostic blind spot.

Conclusion · 2 of 2

When applied through an indication-driven framework, dual-tracer imaging directly reshapes clinical decision-making in more than half of selected high-risk prostate cancer patients, enabling detection of occult malignancies and guiding pivotal treatment decisions that PSMA PET/CT alone cannot support.

When PSMA is not enough: the diagnostic blind spots of PSMA PET/CT and the added value of [¹⁸F]FDG in high-risk prostate cancer: dual-tracer cohort study.

When PSMA is not enough: the diagnostic blind spots of PSMA PET/CT and the added value of [¹⁸F]FDG in high-risk prostate cancer: dual-tracer cohort study.

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