To evaluate the diagnostic performance of (¹⁸F)-PSMA-1007 PET/CT in prostate cancer patients with biochemical recurrence (BCR) after radical prostatectomy and the effect of (¹⁸F)-PSMA-1007 PET/CT on treatment strategy.

A total of 114 patients with BCR after radical prostatectomy who performed (¹⁸F)-PSMA-1007 PET/CT were retrospectively analyzed. The Gleason scores (GS), maximum standardized uptake values (SUV_max) and the diagnostic performance were compared according to different prostate-specific antigen (PSA) groups. To evaluate the impact of (¹⁸F)-PSMA-1007 PET/CT on treatment management, we also collected subjects’ therapy before and after PET/CT. The PSA value was monitored to evaluate the biochemical response.

(¹⁸F)-PSMA-1007PET/CT was positive in 92/114 patients (80.7%). The detection rates were 20/34 (58.8%), 13/17 (76.5%), 15/17 (88.2%) and 44/46 (95.7%) for PSA levels of 0.2-<0.5, 0.5-<1, 1-<2, ≥2 ng/ml. The positive lesions on PET/CT revealed local recurrence in 24/114 (21.1%) patients, lymph nodes metastases in 54/114 (47.4%) and metastatic sites in bone, lung, and others in 75/114 (65.8%). A significant positive correlation was observed between the GS/ SUV_max and PSA level (r₁ = 0.375, r₂ = 0.336, P<0.001). As a result of the (¹⁸F)-PSMA-1007 PET/CT, therapeutic decision-making changed in 60/114 (52.6%) patients. With a follow-up of 11.0 ± 6.4 months, 81/114 PSA were collected after treatment guided by (¹⁸F)-PSMA-1007 PET/CT, and in 42/81 (51.9%) of patients, serum PSA levels decreased of more than 60%.

(¹⁸F)-PSMA-1007 PET/CT has a high lesion detection rate for recurrent prostate cancer (PCa) and could have significant implications in decision-making treatment plan for the majority of PCa patients.