Positron emission tomography (PET) imaging in prostate cancer has advanced significantly in the past decade with prostate cancer targeted radiopharmaceuticals now playing a growing role in diagnosis, staging, and treatment. This narrative review focuses on the most commonly used PET radiopharmaceuticals in the USA: prostate-specific membrane antigen (PSMA), fluciclovine, and choline. 18F-fluorodeoxyglucose (FDG) is used in many other malignancies, but rarely in prostate cancer. Previous literature is discussed regarding each radiopharmaceutical's utility in the settings of screening/diagnosis, initial staging, biochemical recurrence, advanced disease, and evaluation prior to targeted radiopharmaceutical therapy and radiation therapy. PET imaging has demonstrated utility over traditional imaging in various scenarios; however, there are few head-to-head studies comparing PET radiopharmaceuticals. PSMA radiopharmaceuticals are the newest tracers developed and have unique properties and uses, especially at low prostate-specific antigen (PSA) levels. However, each PET radiopharmaceutical has different properties which can affect image interpretation. Choline and fluciclovine have minimal urinary activity, whereas PSMA agents can have high urinary activity which may affect locoregional disease evaluation. Of the three radiopharmaceuticals, only PSMA is approved for both diagnostic and therapeutic indications with 177Lu-PSMA. A variety of diagnostic PET radiotracers for prostate cancer allows for increased flexibility, especially in the setting of supply chain and medication shortages. For the time being, keeping a diverse group of PET radiopharmaceuticals for prostate cancer is justifiable.

中文翻译：

---

前列腺 PET 成像的临床实践。

前列腺癌的正电子发射断层扫描 (PET) 成像在过去十年中取得了显着进展，前列腺癌靶向放射性药物现在在诊断、分期和治疗中发挥着越来越大的作用。本叙述性综述重点关注美国最常用的 PET 放射性药物：前列腺特异性膜抗原 (PSMA)、氟西洛文和胆碱。18F-氟脱氧葡萄糖 (FDG) 用于许多其他恶性肿瘤，但很少用于前列腺癌。先前的文献讨论了每种放射性药物在筛查/诊断、初始分期、生化复发、晚期疾病以及靶向放射性药物治疗和放射治疗之前的评估中的效用。PET 成像在各种情况下都证明了其优于传统成像的实用性；然而，很少有比较 PET 放射性药物的头对头研究。PSMA 放射性药物是最新开发的示踪剂，具有独特的特性和用途，特别是在前列腺特异性抗原 (PSA) 水平较低的情况下。然而，每种 PET 放射性药物具有不同的特性，可能会影响图像判读。胆碱和氟昔洛芬的泌尿活性极低，而 PSMA 药物的泌尿活性较高，可能会影响局部疾病评估。在这三种放射性药物中，只有 PSMA 被批准用于 177Lu-PSMA 的诊断和治疗适应症。各种前列腺癌诊断 PET 放射性示踪剂可以提高灵活性，特别是在供应链和药物短缺的情况下。目前，针对前列腺癌保留多种 PET 放射性药物是合理的。