SYSTEMATIC REVIEW article
Front. Med.
Sec. Nuclear Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1607227
This article is part of the Research TopicEnhancing Prostate Cancer Diagnosis: Biomarkers and Imaging for Improved Patient OutcomesView all 12 articles
Diagnostic value of dual-tracer PET/CT with [ 18 F]FDG and PSMA ligands in Prostate Cancer: an updated sistematic review
Provisionally accepted
Cesare Michele Iacovitti1
Marco Cuzzocrea1
Alessio Rizzo2
Matteo Bauckneht3
Roberto C. Delgado Bolton4
Gaetano Paone1
Giorgio Treglia1,5,6*- 1Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- 2IRCCS Candiolo Cancer Institute, Turin, Piedmont, Italy
- 3University of Genoa, Genoa, Liguria, Italy
- 4Biomedical Research Center of La Rioja- CIBIR, Logroño, La Rioja, Spain
- 5Université de Lausanne, Lausanne, Vaud, Switzerland
- 6University of Italian Switzerland, Lugano, Ticino, Switzerland
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Background: Prostate-specific membrane antigen (PSMA) ligand PET/CT has significantly improved prostate cancer (PCa) imaging. However, in patients with poorly differentiated PCa or neuroendocrine transdifferentiation, [ 18 F]fluorodeoxyglucose ([ 18 F]FDG) PET/CT may provide additional diagnostic information. This systematic review evaluates the diagnostic value of combining [ 18 F]FDG PET/CT with PSMA ligand PET/CT in PCa patients. Methods: A systematic literature search of studies assessing the added diagnostic value of dual tracer [ 18 F]FDG and PSMA ligands PET/CT in PCa patients was conducted using PubMed/MEDLINE and Cochrane Library databases and available information were summarized. Results: Fourteen studies (n = 901 patients) met the inclusion criteria. The dual-tracer approach identified [ 18 F]FDG-positive/PSMA-negative (FDG+/PSMA-) lesions in a subset of patients, particularly those with Gleason Score (GS) ≥ 9. However, in patients with GS < 8, [ 18 F]FDG PET/CT did not significantly improve lesion detection over PSMA ligand PET/CT alone. The presence of FDG+/PSMA-lesions correlated with aggressive tumor biology, increased risk of metastases, and worse prognosis. Conclusion: Literature data showed that [ 18 F]FDG PET/CT may serve as a valuable complementary imaging modality for high risk PCa patients potentially influencing staging and treatment decisions. Future prospective studies are warranted to further elucidate the prognostic significance and cost-effectiveness of combining [ 18 F]FDG PET/CT with PSMA ligand PET/CT in PCa patients.
Keywords: prostate cancer, PSMA, [ 18 F]FDG, PET/CT, dual-tracer, hybrid imaging, diagnostic, Gleason Score
Received: 07 Apr 2025; Accepted: 12 Jun 2025.
Copyright: © 2025 Iacovitti, Cuzzocrea, Rizzo, Bauckneht, Delgado Bolton, Paone and Treglia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Giorgio Treglia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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