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Patients underwent PET\/CT 60\u00a0minutes post-\n                      <jats:sup>18<\/jats:sup>\n                      F-piflufolastat (9\u00a0mCi) administration, and a second PET\/CT on the same scanner 1\u201310\u00a0days later, 60\u00a0minutes post-\n                      <jats:sup>18<\/jats:sup>\n                      F-flotufolastat (8\u00a0mCi) administration. The primary endpoint was the difference in urinary radioactivity (SUV\n                      <jats:sub>mean<\/jats:sub>\n                      ) between the radiopharmaceuticals. Secondary endpoints included patient-level and region-level DR for each radiopharmaceutical, assessed by two blinded readers (a third resolved disagreements, allowing majority reads).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty-five evaluable patients (mean PSA, 0.28\u00a0ng\/mL) were enrolled. Median bladder SUV\n                      <jats:sub>mean<\/jats:sub>\n                      was significantly higher with\n                      <jats:sup>18<\/jats:sup>\n                      F-piflufolastat (29.0; interquartile range, 18.9\u201340.8) than\n                      <jats:sup>18<\/jats:sup>\n                      F-flotufolastat (10.9; interquartile range, 6.0\u201318.5;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 [Wilcoxon signed-rank test]). Majority read patient-level DR were 27.3% (15\/55) for\n                      <jats:sup>18<\/jats:sup>\n                      F-piflufolastat and 45.5% (25\/55) for\n                      <jats:sup>18<\/jats:sup>\n                      F-flotufolastat. Region-level DR for\n                      <jats:sup>18<\/jats:sup>\n                      F-piflufolastat and\n                      <jats:sup>18<\/jats:sup>\n                      F-flotufolastat, were 10.9% (6\/55) and 18.2% (10\/55) in the prostate bed, 14.5% (8\/55) and 16.4% (9\/55) in pelvic lymph nodes, and 7.3% (4\/55) and 21.8% (12\/55) in extra-pelvic sites. Among patients with PSA \u22640.2\u00a0ng\/mL, 38.1% (8\/21) and 52.4% (11\/21) had positive\n                      <jats:sup>18<\/jats:sup>\n                      F-piflufolastat and\n                      <jats:sup>18<\/jats:sup>\n                      F-flotufolastat scans, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This intra-patient comparator shows\n                      <jats:sup>18<\/jats:sup>\n                      F-flotufolastat has significantly lower urinary radioactivity than\n                      <jats:sup>18<\/jats:sup>\n                      F-piflufolastat, which may help to optimise image assessment in regions close to the urinary tract.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>Trial registration, clinicaltrials.gov: NCT06604442. Registered September 2024.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07732-y","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T10:03:27Z","timestamp":1771841007000},"page":"3529-3541","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An intra-patient contemporaneous comparison of 18F-piflufolastat and 18F-flotufolastat urinary radioactivity and pelvic region detection rates in men with low PSA biochemical recurrence of prostate cancer after radical prostatectomy"],"prefix":"10.1007","volume":"53","author":[{"given":"Luke T.","family":"Nordquist","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack R.","family":"Andrews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip H.","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin A.","family":"Gartrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Josephson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei S.","family":"Purysko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Saltzstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram A.","family":"Pathak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal","family":"Shore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Sykes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Penny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7707-3318","authenticated-orcid":false,"given":"Brian T.","family":"Helfand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"7732_CR1","first-page":"14","volume":"11","author":"CJ Paller","year":"2013","unstructured":"Paller CJ, Antonarakis ES. 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Int J Radiat Oncol Biol Phys. 2024;120(2):S148\u20139. https:\/\/doi.org\/10.1016\/j.ijrobp.2024.07.2159.","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["European Journal of Nuclear Medicine and Molecular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07732-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00259-025-07732-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07732-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:10:49Z","timestamp":1781629849000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00259-025-07732-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":33,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["7732"],"URL":"https:\/\/doi.org\/10.1007\/s00259-025-07732-y","relation":{},"ISSN":["1619-7070","1619-7089"],"issn-type":[{"value":"1619-7070","type":"print"},{"value":"1619-7089","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,23]]},"assertion":[{"value":"23 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki and the International Council on Harmonisation Guidelines for Good Clinical Practice. The study protocol was approved by each study site\u2019s Institutional Review Board\/Independent Ethics Committee prior to initiation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"All patients provided written informed consent prior to study participation.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Jack R. Andrews has participated in advisory boards for Blue Earth Diagnostics Ltd., Bayer, and Novartis. Benjamin A. Gartrell has received research funding from Pfizer and has served on advisory boards\/speaker\u2019s bureau for Bayer, Eisai, Johnson & Johnson, Novartis, Pfizer, Astellas, Blue Earth Diagnostics, Seagen, Aveo and BMS. Phillip H. Kuo has received research grants from Blue Earth Diagnostics and General Electric Healthcare. He is a consultant and\/or speaker for Attralus, Bayer, Blue Earth Diagnostics, dGenThera, Eli Lilly, Fusion Pharma, General Electric Healthcare, Global Medical Solutions, Invicro\/Perceptive, Life Molecular Imaging, Merck, Navidea, Novartis, Radionetics, Telix Pharmaceuticals, and United Imaging, and participates on a scientific advisory board for dGenThera. Andrei S. Purysko has received a research grant for the present study, and consulting fees, from Blue Earth Diagnostics Ltd., and has received research grants from Lantheus Diagnostic and Therapeutic Innovations and Siemens Healthineers. James Sykes and Ross Penny are employees of Blue Earth Diagnostics Ltd. Phillip Davis was an employee of Blue Earth Diagnostics Inc. during the time this study was conducted. Brian T. Helfand reports research funding from Blue Earth Diagnostics for the present study. All other authors have no relevant disclosures.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}