Table 1.

Diagnostic performance, advantages, and disadvantages of different radiotracers in the evaluation of the primary staging of prostate cancer.

Radiotracer	Lesion Site	Sensitivity (%)	Specificity (%)	Advantages	Disadvantages	Reference
[18F]FDG	T	37–52 67~	- 72~	Providing prognostic information. Incidental uptake is a warning sign. Widely available.	Limitation in well-differentiated PCa. Uptake overlap in malignant and benign lesions. Urinary excretion.	[32,34,35,38,41,44,181]
[11C/18F]Choline	T	62	76		Non-specific for tumoral lesions. Limited sensitivity. No association between the intensity of uptake with histopathologic or laboratory parameters. Urinary excretion.	[11,54,55,56,57]
	LN	50–59 51 *	92–95 99 *	High specificity. Node-based sensitivity higher than conventional imaging.	Limited value in small LNs.	[56,58,59]
	BM	95	91	Detecting early marrow metastasis. Comparable sensitivity with MRI.	Inferior sensitivity in comparison with Na[18F]F PET/CT.	[60,61,62,63]
[11C]Acetate	T	93 75 *	- 73 *	Non-urinary excretion. Imaging in 20 min after injection.	Non-specific for tumoral lesions. Limited sensitivity. No association between the intensity of uptake with histopathologic or laboratory parameters. Limited availability.	[12,46,70,71,72,73,74]
	LN	73	-		Suboptimal sensitivity for small LN metastasis.	[12,76]
[68Ga]Ga-PSMA	T	70 *	84 *	Moderate sensitivity and high specificity for the detection of local tumor extent. Correlation between SUVmax of the primary tumor and GS, PSA and probability of presence of distant metastases.	Limited sensitivity for small lesions. Lower uptake in tumors with lower GS. Urinary excretion.	[81,83,84,85,87,88,89]
	LN	61–84	95–97	High specificity.	Suboptimal sensitivity for small LN metastasis.	[83,92,93,95]
	BM	97	100	Higher sensitivity and specificity compared to bone scan. Superior sensitivity compared to MRI. Comparable diagnostic value compared to Na[18F] F PET/CT.		[63,96]
[18F]PSMA	T	95–100	-	Lower positron energy/higher spatial resolution. Non-urinary excretion. Good correlation with mpMRI and histopathology.		[107,108,109,111,112,120,121,122]
	LN	87 § 71.2 *,§ 28.1–52.5 ¤	98 § 99.5 *,§ 94.0–99.4 ¤	High spatial resolution (detection of smaller LNs. Low rate of false positive results.		[108,112,124,126,127,128]
	DM	86–95% §	76–90% §	Superior to bone scan and MRI.	Biliary excretion (limiting detection of liver metastases). Non-specific uptake in bone lesions.	[129,130]
[18F]Fluciclovine	T	86.3	75.5		Non-specific for tumoral lesions.	[151,153]
	LN	40	100	High specificity.	Limited sensitivity.	[154,155]
[99mTc]PSMA	T	94–100	-	High accuracy for detecting primary lesions. Maybe helpful for guided biopsy in suspicious patients with negative biopsies.	Urinary excretion.	[17,143,144]
	LN	50	87	Good specificity.	Low sensitivity	[143]
Na[18F]F	BM	96	97	High sensitivity	Non-specific agent. Only bone lesions.	[63]
[111In]In- capromab pendetide	LN	62	72		Limited sensitivity. Poor image quality.	[25]
[18F]FDHT	T	63	86	Non-invasive evaluation of hormone receptor status. Correlation between a positive scan and higher PSA level.	Low sensitivity. Limited availability.	[161,162]
[68Ga]Ga-RM2	T	88	81	High lesion-based sensitivity for primary lesion.		[166]
		70	-		Limited sensitivity for LN metastasis.	[173]

~ in both staging and re-staging; * Lesion-based; ^§ [¹⁸F]PSMA; ^¤ [¹⁸F]FDCFPyL; AUC: area under curve; BM: bone metastasis; DM: distant metastasis; FDG: fluorodeoxyglucose; FDHT: 16beta-18F-fluoro-5-alpha-dihydrotestosterone; GS: Gleason score; LN: lymph node; mpMRI: multiparametric magnetic resonance imaging; PCa: prostate cancer; PET/CT: positron emission computed tomography/computed tomography; PSA: prostate-specific antigen; PSMA: prostate-specific membrane antigen; SUV_max: maximum standardized uptake value; T: primary tumor; WD: well-differentiated.