One-stop shop-integrating 18 F-PSMA-1007 and 11 C-acetate positron-emission tomography with multiparametric magnetic resonance imaging for prostate cancer: A prospective study.

[BACKGROUND] To evaluate the diagnostic performance and clinical utility of integrating 18F-PSMA-1007 PET, 11C-acetate PET, and multiparametric MRI (mpMRI) in a one-stop-shop PET/MRI protocol for intermediate- to high-risk prostate cancer staging.

[METHOD] This prospective study enrolled 22 patients with biopsy-confirmed, intermediate- to high-risk prostate cancer. All underwent simultaneous 18F-PSMA-1007 PET/MRI, followed by 11C-acetate PET in a dual-tracer design. Lesion detection, concordance across modalities, and region-based sensitivity, specificity, PPV, and NPV were analyzed. The impact on clinical management was also assessed.

[RESULTS] 18F-PSMA-1007 PET showed superior detection of both nodal and distant metastases, with region-based sensitivity of 75.0%, specificity of 100.0%, and NPV of 92.0%. Discordant findings between PET and mpMRI occurred in 34.8% of cases, but integrated interpretation improved lesion characterization. PSMA PET alone identified clinically significant findings in 22.7% of patients. 11C-acetate did not detect any additional lesions and served as a supplementary tool. The combined PET/MRI workflow enhanced diagnostic confidence while reducing interpretive delay.

[CONCLUSION] The integration of dual-tracer PET and mpMRI into a single PET/MRI session provides a feasible, efficient, and potentially impactful strategy for prostate cancer staging. This protocol supports biologically-informed, patient-specific decision-making and may serve as a model for future risk-adapted workflows.