How to cite: Vargas A. “Which PSMA Radiotracer is Best for Which Setting?” Grand Rounds in Urology. October 23, 2025. Accessed Oct 2026. https://grandroundsinurology.com/which-psma-radiotracer-is-best-for-which-setting/
Summary
Alberto Vargas, MD, Vice Chair of Oncology Imaging and Strategy, and Professor, Department of Radiology, New York University, New York, New York, addresses which prostate-specific membrane antigen positron emission tomography (PSMA PET) radiotracers should be selected for different clinical settings. Dr. Vargas states that there is currently no clinical evidence demonstrating the superiority of one FDA-approved PSMA radiotracer over another in terms of diagnostic performance.
Dr. Vargas explains that PSMA PET is an umbrella term encompassing multiple ligands that all target the extracellular domain of the PSMA receptor. This shared mechanism distinguishes modern tracers from earlier failed agents that targeted the intracellular domain. All currently approved tracers are internalized after receptor binding, enabling high-quality imaging without requiring cell death or membrane disruption.
The differences between tracers are reviewed primarily from a physical and logistical standpoint. Gallium-68- and fluorine-18-labeled compounds are compared, highlighting differences in positron range, half-life, production method, and renal excretion. While copper-based tracers offer theoretical advantages, such as a shorter positron range and a longer half-life, Dr. Vargas emphasizes that these differences have not translated into proven clinical benefit.
In comparative studies and meta-analyses are reviewed, demonstrating similar lesion detection rates, standardized uptake values, and overall diagnostic accuracy across tracers. Variability is more often observed in benign findings than in cancer detection, reinforcing the importance of reader experience and standardized interpretation frameworks.
A Q&A session is dominated by practical considerations. Access, institutional expertise, logistics, reimbursement, and cost are identified as the most relevant factors guiding tracer selection.
Dr. Vargas emphasizes that all FDA-approved PSMA PET tracers are clinically effective and interchangeable, and that multidisciplinary collaboration and reader expertise have a greater impact on patient care than tracer choice itself.
About the 28th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, Richard G. Stock, MD, and William K. Oh, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.
ABOUT THE AUTHOR
Alberto Vargas, MD, is Vice Chair of Oncology Imaging and Strategy, and a Professor within the Department of Radiology at New York University in New York City. Dr. Vargas specializes in oncological and molecular imaging. His clinical and research interests focus on the use of advanced-imaging modalities, including diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging and novel positron emission tomography tracers for the non-invasive diagnosis, staging, treatment response assessment, and follow-up of patients with cancer. Dr. Vargas is especially interested in imaging patients with cancers involving the urinary system and the female reproductive organs.
