The Reading Room Podcast: A Closer Look at Comparative Research on PSMA PET Agents in Men with Low PSA Values

For patients with prostate cancer (PCa), Jack Andrews, MD, a urologic oncologist, said PSMA PET imaging can play a significant role in personalizing treatment.

“My hope is that as we improve with our imaging and our other biomarkers, we can really help select those men who can avoid salvage pelvic radiation and can get more targeted, specific metastasis-directed therapy,” explained Dr. Andrews during a recent Reading Room podcast.

“ … I'm really excited to see how that that evolves because ultimately, we want to get the right therapy to the right patient. We want to intensify therapy for the correct patient and de-intensify the therapy to avoid some side effects for the patients who don't need more intensified therapy. I think PSMA PET is a really valuable component of that personalization.”

During the podcast, Dr. Andrews shared his insights on findings from a recent phase 4 trial that compared the use of ¹⁸F-flotufolastat (Posluma, Blue Earth Diagnostics) and ¹⁸F-piflufolastat (Pylarify, Lantheus) in 55 men with a median PSA of 0.28 ng/mL).¹

What the Comparative Study Revealed About PCa Detection Rates for ¹⁸F-flotufolastat and ¹⁸F-piflufolastat in Patients with Low PSA Values

The study findings, recently presented at the American Society for Radiation Oncology (ASTRO) conference, revealed that ¹⁸F-flotufolastat had:

• an 18 percent higher patient-level detection rate (DR) (45 percent vs. 27 percent);

• a 19 percent higher DR in patients with biochemical recurrence (BCR) occurring less than five years after radical prostatectomy (50 percent vs. 31 percent); and

• consistently higher DR at PSA levels as low as < 0.1 ng/mL and more than double the DR among patients with an initial NO diagnosis (42 percent vs. 21 percent).

Dr. Andrews cautioned that the study was only powered to evaluate the urinary excretion of the two PSMA PET agents and affirmed that it was lower with ¹⁸F-flotufolastat. While noting that the study’s DR findings were not statistically significant, Dr. Andrews said some cases were “quite striking” in the differences between ¹⁸F-flotufolastat and ¹⁸F-piflufolastat.

“ … There are a few patients (in whom) you cannot see disease at the vesicourethral anastomosis with the ¹⁸F-piflufolastat scan, but on the ¹⁸F-flotufolastat scan, it's very obvious, and I think that's really what the hope is. We're hoping to make this where radiologists and nuclear medicine doctors who are reading these scans can see it from a mile away to make their job easier to help give us a higher level of personalization for our treatment decisions,” noted Dr. Andrews, an assistant professor of urology at the Mayo Clinic in Rochester, Minn.

For more insights from Dr. Andrews, listen below or subscribe on your favorite podcast platform.

Reference

1. Andrews JR, Sykes J, Cohen T. Impact of clinical factors on ¹⁸F-piflufolastat and ¹⁸F-flotufolastat detection rates in patients with recurrent prostate cancer post-prostatectomy: results from an intra-patient head-to-head study. Presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, September 26-September 30, 2026, Boston. Available at: https://www.astro.org/meetings-and-education/micro-sites/2026/annual-meeting .

(Editor’s note: This podcast was originally published as an episode of our Molecular Imaging in Focus series at the following link: https://www.diagnosticimaging.com/view/molecular-imaging-in-focus-comparative-psma-pet-study-insights-men-recurrent-pca-low-psa-values .)