评估18F-DCFPyL PET/CT与18F-Fluorocholine在中高风险前列腺癌(PCa)初始分期中的诊断和治疗影响。将没有进行雄激素剥夺疗法和之前进行18F-Fluorocholine PET/CT检查的中高风险PCa新诊断患者（排除有外前列腺疾病或类播转移病变者）转诊至18F-DCFPyL PET/CT。获取患者的疾病特征，如分级组，D'Amico风险类别（中高风险），最接近PET/CT的前列腺特异性抗原(PSA)值及其动力学。评估两种示踪剂的整体检出率(DR)和分子显像TNM(miTNM)分期，根据前列腺癌分子成像标准评估(PROMISE)标准，分析它们的一致性（Kappa系数）。评估18F-DCFPyL与18F-Fluorocholine在诊断和治疗方面的影响。共分析了58名患者（84.5%为高风险）。18F-Fluorocholine在涉及前列腺腺体（100% vs. 93.1%）和盆腔淋巴结疾病（37.9% vs. 31%）的DR高于18F-DCFPyL（k=0.436，p=0.001）。另一方面，18F-DCFPyL PET/CT在转移性疾病的DR上优于18F-Fluorocholine PET/CT，9/58名患者（15.5%）：3例M1a，5例M1b和1例M1c) vs. 5/58名患者（8.6%）：1例M1a和4例M1b)，k=0.426, p=0.001。未发现18F-Fluorocholine或18F-DCFPyL结果与临床特征（分级组、风险类别、PSA水平和动力学）之间的显著关联。18F-DCFPyL-PET/CT的结果与之前计划的治疗相比，修改了13名患者（22.4%）的治疗方案。18F-Fluorocholine和18F-DCFPyL PET/CT在前列腺腺体和淋巴结受累范围上的DR相似，虽然后者的一致性中等。18F-DCFPyL在检测区域性和远处转移方面优于18F-Fluorocholine，且在五分之一的患者中具有治疗影响。© 2023. 作者授权独家给日本核医学会。

To assess the diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL with respect to 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer (PCa).Patients with recent diagnosis of intermediate-/high-risk PCa without androgen deprivation therapy and previous 18F-Fluorocholine-PET/CT (negative for extraprostatic disease or with oligometastatic disease) were referred to 18F-DCFPyL-PET/CT. Patients' disease characteristic as grade group, D'Amico risk category (intermediate/high), prostate-specific antigen (PSA) closest to PET/CTs and its kinetics were obtained. The overall detection rate (DR) and molecular imaging TNM (miTNM) stage according to the prostate cancer molecular imaging standardized evaluation (PROMISE) criteria were assessed for both radiotracers, and their concordance (Kappa coefficient) was analyzed. The diagnostic and therapeutic impact of 18F-DCFPyL with respect to 18F-Fluorocholine was evaluated.Fifty-eight patients were analyzed (84.5% high-risk). 18F-Fluorocholine showed a higher DR than 18F-DCFPyL of prostate gland involvement (100% versus 93.1%) and pelvic node disease (37.9% versus 31%; k = 0.436, p = 0.001). On the other hand, 18F-DCFPyL-PET/CT showed a higher DR of metastatic disease than 18F-Fluorocholine-PET/CT, 9/58 patients (15.5%): 3 M1a, 5 M1b and 1 M1c) versus 5/58 (8.6%) patients: 1 M1a and 4 M1b), k = 0.426; p = 0.001. No significant association was found between clinical characteristics (grade group, risk category, PSA level and kinetic) and 18F-Fluorocholine or 18F-DCFPyL results. The results of 18F-DCFPyL-PET/CT modified the previously planned treatment compared to 18F-Fluorocholine-PET/CT in 13 patients (22.4%).18F-Fluorocholine and 18F-DCFPyL PET/CT showed a similar DR of prostate gland and lymph node involvement, although with moderate concordance for the latter. 18F-DCFPyL was superior to 18F-Fluorocholine in detecting regional and distant metastasis with a therapeutic impact in one of every five patients.© 2023. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.