Impact of reduced scan extent on tumor detection in ⁶⁸Ga-PSMA PET/CT for biochemical recurrence of prostate cancer.

Authors

Falk Gühne, Alexander Küppers, Christian Kühnel, Philipp Seifert, Martin Freesmeyer

Published in

BMC medical imaging. Volume 26. Issue 1. Oct 21, 2026. Epub Oct 21, 2026.

Abstract

PSMA PET/CT plays an important role in biochemically recurrent prostate cancer (BCR-PCa). In general, PET/CT is performed as a limited or true whole-body examination. The majority of PET/CT scanners operate by measuring several bed positions or continuous motion with a limited axial field of view (FOV). Shortening the scan area thus results in a time saving, with unknown information loss regarding the detection of tumor manifestations.
This retrospective single-center study included 200 patients with BCR-PCa after initial curative therapy who underwent a ⁶⁸Ga-PSMA-PET/CT scan from vertex to toe (true whole-body). Using retrospective subdivision into hypothetical partial body measurement protocols, the undetected tumor manifestations were examined. Classic PET/CT protocols were used: vertex to mid-thigh, skull base to mid-thigh, as well as CT-equivalent examination areas: chest/abdomen/pelvis (CAP), abdomen/pelvis (AP) and pelvis.
Of 200 patients with a median PSA of 1.1 ng/mL, 128 (64%) showed at least one structural correlate of BCR-PCa in the true whole-body scan. The overall detection rate did not change for limited classic PET-protocols, or CAP measurements. CAP scans would not have detected all tumor manifestations in 16 patients (8%) and not all tumor-affected organ systems in six patients (3%), AP scans in 41 patients (21%) and 18 patients (9%), pelvic scans in 61 patients (31%) and 37 patients (19%), respectively. PSA may contribute to the prospective restriction of the scan area. Patients with PSA ≤ 0.75 ng/mL showed no diagnostic gain from whole-body imaging. This means that in 45% of patients in our cohort, a limitation to CAP scan would have been possible without losing information.
For a resource-saving use of routine PSMA-PET/CT, a scan from the vertex to the mid-thigh seems sufficient for detecting relevant metastases. For patients with low PSA levels, a more focused protocol that includes only the CAP region can be considered.

PMID:
42907742
Bibliographic data and abstract were imported from PubMed on 23 Oct 2026.

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