{
  "abstract": "Background and Importance Piflufolastat is a radiopharmaceutical targeting the prostate-specific membrane antigen (PSMA), used in positron emission tomography (PET). Its high affinity enables better lesion detection in prostate cancer compared to tracers like choline. This improved diagnostic performance may influence clinical decisions, especially in biochemical recurrence.Aim and Objectives To assess the clinical utility and diagnostic performance of piflufolastat in biochemically recurrent prostate cancer and its impact on disease detection and treatment strategies.Material and Methods A retrospective, multicentre, descriptive study was conducted during 2023–2024, including prostate cancer patients previously treated with radical prostatectomy or curative radiotherapy. Eligible patients had biochemical progression, persistence, or recurrence and were candidates for piflufolastat PET per Central Pharmacy and Therapeutics Commission protocol. Variables included age, Gleason score, initial treatment, PSA prior to imaging, PET-choline and PET-PSMA results (negative, positive, or indeterminate), and post-imaging treatment. Data were obtained from electronic medical records.Results Thirty-two patients (mean age: 68 years) were included. Gleason scores were 6 (19%), 7 (70%), 8 (4%), and 9 (7%). Most underwent radical prostatectomy (n=28), four received curative radiotherapy. Mean PSA before imaging: 1.62 ng/ml. Average interval between PET-choline and PET-PSMA: 2.7 months.Discordance between the two imaging occurred in 66% of cases. PET-PSMA was positive in 12 patients with negative PET-choline, and indeterminate in three others. Among five indeterminate PET-choline cases, three were positive and two negative on PET-PSMA.Treatment decisions varied: among PET-PSMA positive patients, six received androgen deprivation therapy (ADT) with apalutamide or enzalutamide, two received the same plus radiotherapy, five underwent Stereotactic Body Radiation Therapy (SBRT), three received ADT and radiotherapy, and one underwent cryotherapy.Among PET-PSMA negative patients, four were under active surveillance, one received SBRT, three received ADT and radiotherapy, and one received ADT plus enzalutamide. In indeterminate PET-PSMA cases, two received ADT and apalutamide, two received ADT and radiotherapy, and two were closely monitored.Conclusion and Relevance Piflufolastat PET is a valuable diagnostic tool for assessing recurrence in prostate cancer, especially in patients with negative PET-choline. Its higher sensitivity may influence treatment decisions. However, this study did not show consistent correlation between PET-PSMA findings and therapeutic strategies. Further studies are needed to clarify its impact on clinical outcomes.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Badajoz University Hospital, Pharmacy, Badajoz, Spain"
      ],
      "name": "M Gragera Gómez"
    },
    {
      "affiliations": [
        "Badajoz University Hospital, Pharmacy, Badajoz, Spain"
      ],
      "name": "H Velazquez Vazquez"
    },
    {
      "affiliations": [
        "Badajoz University Hospital, Pharmacy, Badajoz, Spain"
      ],
      "name": "MD Zambrano Croche"
    }
  ],
  "title": "4CPS-003 Beyond choline: the role of piflufolastat in guiding treatment for recurrent prostate cancer",
  "uid": "efdf4467-d7dc-56be-b7d3-a4f96fa0055a"
}