figure a

Local recurrence of prostate cancer after primary local therapy presents challenges for urologists and imaging procedures, especially in patients with low prostate-specific antigen (PSA) values. Recently, 68Ga prostate-specific membrane antigen (PSMA)-11 has shown promising detection rates, and is gaining adoption worldwide in clinical routine [1]. However, there are a significant number of patients in whom local recurrence cannot be differentiated from activity by urinary tracer excretion. The use of 18F–PSMA-1007 was recently presented, and showed a delayed renal excretion [2], which may aid clinicians in making meaningful decisions regarding therapy management in these patients. Here we present images of a 74-year-old prostate cancer patient after radical prostatectomy (Gleason score 9) with biochemical recurrence (PSA: 2.1 ng/dl). Images A and B show 68Ga-PSMA-11 PET-CT (A: maximum-intensity projection, MIP; B: fused axial PET-CT image). Arrows show minimal pararectal uptake close to the bladder and the ureter, for which clinical decision making is problematic. Images C and D show 18F–PSMA-1007 PET-CT of the same patient (C: MIP, D: fused axial PET-CT image). Arrows show unequivocal focal uptake representing a local recurrence, with high contrast (maximum standard uptake value: 9.9), with no distracting ureteral or vesical excretion activity. 18F–PSMA-1007 seems to be superior to 68Ga-PSMA-11 in cases of biochemical recurrence and unclear lesions close to the ureter or urinary bladder.