What is it about?
Prostate cancer imaging has advanced significantly with the introduction of PSMA PET/CT, a scan designed to identify prostate cancer cells throughout the body. However, not all prostate cancers behave in the same way. Some aggressive tumors may become less visible on PSMA imaging, potentially leaving important disease undetected. Our research investigated whether combining PSMA PET/CT with another imaging technique, FDG PET/CT, could provide a more complete picture of cancer in selected patients with high-risk prostate cancer.
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Why is it important?
We studied 82 patients with prostate cancer who underwent both PSMA PET/CT and FDG PET/CT at Bursa Uludağ University Hospital in Türkiye. The two scans detect different biological characteristics of tumors. PSMA imaging targets a protein commonly expressed by prostate cancer cells, while FDG imaging measures glucose metabolism, which is often increased in aggressive cancers. We examined whether the second scan revealed additional findings and whether these findings influenced clinical decisions. What did we discover? Adding FDG PET/CT influenced clinical management in 51.2% of patients (42 out of 82). We also identified separate primary cancers in 30.5% of patients (25 out of 82), particularly lung and colorectal cancers. Importantly, FDG imaging helped identify suspicious abnormalities that were not apparent on PSMA imaging alone, including findings potentially associated with more aggressive tumor behavior. Why does this matter? Our findings demonstrate that even highly advanced imaging techniques have limitations. For selected patients with high-risk prostate cancer, using two complementary scans may help clinicians recognize additional cancers, investigate aggressive disease, and make more informed treatment decisions. This does not mean that every patient with prostate cancer requires both scans. Instead, our research supports considering FDG PET/CT when clinical findings suggest that PSMA imaging alone may not provide the complete picture.
Perspectives
As a nuclear medicine physician, I have always been interested in understanding not only what molecular imaging can detect, but also what it may miss. This study was motivated by an important clinical observation: although PSMA PET/CT has transformed prostate cancer imaging, some aggressive tumors and unrelated primary malignancies may remain undetected when relying on PSMA imaging alone. What I found particularly meaningful was that adding FDG PET/CT influenced clinical management in more than half of our selected patients. This reinforced my belief that understanding tumor biology is just as important as using advanced imaging technology. For me, the central message of this research is that no single imaging modality tells the complete story. Recognizing the limitations of our diagnostic tools and knowing when to combine complementary techniques can make a meaningful difference in clinical decision-making. I hope this work encourages clinicians to consider a more individualized, biology-driven approach to imaging patients with complex prostate cancer.
Efrah Ahmed Ibrahim
Uludag Universitesi
Read the Original
This page is a summary of: 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, Cancer Imaging, July 2026, Springer Science + Business Media,
DOI: 10.1186/s40644-026-01084-y.
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