前列腺特异性膜抗原（PSMA）基于PET/CT成像在前列腺癌（PCa）的诊断上有限制。我们招募了207名有可疑PCa的参与者，使用放射性标记的胃泌素释放肽受体（GRPR）拮抗剂[68Ga]Ga-RM26 进行PET/CT成像，并与[68Ga]Ga-PSMA-617和组织病理学进行比较。每个可疑PCa的参与者都进行了[68Ga]Ga-RM26和[68Ga]Ga-PSMA-617 PET/CT扫描。PET/CT成像是以病理标本作为参考标准进行比较的。分析的207名参与者中，有125名患有癌症，82名被诊断为良性前列腺增生（BPH）。 [68Ga]Ga-RM26和[68Ga]Ga-PSMA-617 PET/CT成像的灵敏度和特异度在检测临床显著PCa时存在显著差异。[68Ga]Ga-RM26 PET/CT的ROC曲线下面积（AUC）在检测PCa时为0.54，[68Ga]Ga-PSMA-617 PET/CT为0.91。对于临床上显著的PCa成像，其AUC分别为0.51和0.93。[68Ga]Ga-RM26 PET/CT成像在Gleason分数（GS）=6的PCa中具有更高的灵敏度（p = 0.03），但特异度较差（20.73%）。对于PSA <10 ng/mL的组，[68Ga]Ga-RM26 PET/CT的灵敏度、特异度和AUC均低于[68Ga]Ga-PSMA-617 PET/CT（分别为60.00% vs. 80.30%，p = 0.12；23.26% vs. 88.37%，p = 0.000；0.524 vs. 0.822，p = 0.000）。[68Ga]Ga-RM26 PET/CT在GS = 6的标本中（p = 0.04）和低风险组中呈现出显着较高的SUVmax，其摄取量不随PSA水平、GS或临床分期而增加。这项前瞻性研究提供了证据，表明[68Ga]Ga-PSMA-617 PET/CT比[68Ga]Ga-RM26 PET/CT更准确地检测更临床上重要的PCa。[68Ga]Ga-RM26 PET/CT在成像低风险PCa方面具有优势。© 2023年作者，独家授权于德国施普林格-维尔格（Springer-Verlag GmbH Germany）的一部分，施普林格自然出版集团（Springer Nature）

Prostate-specific membrane antigen (PSMA)-based PET/CT imaging has limitations in the diagnosis of prostate cancer (PCa). We recruited 207 participants with suspicious PCa to perform PET/CT imaging with radiolabeled gastrin-releasing peptide receptor (GRPR) antagonist, [68Ga]Ga-RM26, and compare with [68Ga]Ga-PSMA-617 and histopathology.Every participant with suspicious PCa was scanned with both [68Ga]Ga-RM26 and [68Ga]Ga-PSMA-617 PET/CT. PET/CT imaging was compared using pathologic specimens as a reference standard.Of the 207 participants analyzed, 125 had cancer, and 82 were diagnosed with benign prostatic hyperplasia (BPH). The sensitivity and specificity of [68Ga]Ga-RM26 and [68Ga]Ga-PSMA-617 PET/CT imaging differed significantly for detecting clinically significant PCa. The area under the ROC curve (AUC) was 0.54 for [68Ga]Ga-RM26 PET/CT and 0.91 for [68Ga]Ga-PSMA-617 PET/CT in detecting PCa. For clinically significant PCa imaging, the AUCs were 0.51 vs. 0.93, respectively. [68Ga]Ga-RM26 PET/CT imaging had higher sensitivity for PCa with Gleason score (GS) = 6 (p = 0.03) than [68Ga]Ga-PSMA-617 PET/CT but poor specificity (20.73%). In the group with PSA < 10 ng/mL, the sensitivity, specificity, and AUC of [68Ga]Ga-RM26 PET/CT were lower than [68Ga]Ga-PSMA-617 PET/CT (60.00% vs. 80.30%, p = 0.12, 23.26% vs. 88.37%, p = 0.000, and 0.524 vs. 0.822, p = 0.000, respectively). [68Ga]Ga-RM26 PET/CT exhibited significantly higher SUVmax in specimens with GS = 6 (p = 0.04) and in the low-risk group (p = 0.01), and its uptake did not increase with PSA level, GS, or clinical stage.This prospective study provided evidence for the superior accuracy of [68Ga]Ga-PSMA-617 PET/CT over [68Ga]Ga-RM26 PET/CT in detecting more clinically significant PCa. [68Ga]Ga-RM26 PET/CT showed an advantage for imaging low-risk PCa.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.