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This study aims to evaluate the impact of PET\/CT using [<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 and [<jats:sup>18<\/jats:sup>F]FCH in clinical management of recurrent prostate cancer (PCa) and correlates imaging findings with clinical characteristics of PCa.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Procedures<\/jats:title>\n            <jats:p>Forty-six patients with PCa (mean age 68.3\u2009\u00b1\u20096.3 years) with biochemical recurrence were enrolled in this prospective crossover trial. All patients underwent both [<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 and [<jats:sup>18<\/jats:sup>F]FCH PET\/CT within a maximum interval of 12 days (median 7d). A standard randomization tool randomized the sequence of PET\/CT imaging. Clinical decision-making occurred in an interdisciplinary meeting considering PET\/CT findings. PET\/CT-blinded readings were performed 3 months after imaging followed by a consensus meeting for final interpretation of detected lesions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Both imaging modalities detected 136 total malignant lesions. [<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 and [<jats:sup>18<\/jats:sup>F]FCH PET\/CT detected 125 and 60 lesions with a sensitivity of 96% and 48%, respectively. Tumor-to-background ratios and semi-quantitative PET parameters on [<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 were significantly higher in 54 (41.2%) tracer-avid congruent lesions detected on both imaging modalities. [<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 PET\/CT exclusively detected 71 (52.2%) lesions, while 6 (4.4%) lesions were solely seen on [<jats:sup>18<\/jats:sup>F]FCH PET\/CT.<\/jats:p>\n            <jats:p>[<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 and [<jats:sup>18<\/jats:sup>F]FCH PET\/CT were positive in 35\/46 (76%) and 26\/46 (57%) patients, respectively. PET\/CT imaging led to a major treatment change in 4 (8.7%) patients, of which [<jats:sup>18<\/jats:sup>F]FCH PET\/CT had superior impact in one patient.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>[<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 PET\/CT revealed superior diagnostic performance to [<jats:sup>18<\/jats:sup>F]FCH PET\/CT in patients with recurrent PCa, specifically with very low PSA levels\u2009\u2264\u20091 ng\/ml. Moreover, it led to more accurate staging and clinical management of the disease. [<jats:sup>18<\/jats:sup>F]FCH PET\/CT may play a complementary role in rare, select high-risk cases with negative [<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 PET\/CT and ongoing ADT.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11307-025-02020-5","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T12:29:35Z","timestamp":1748435375000},"page":"597-605","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["[68Ga]Ga-PSMA-11 PET\/CT and [18F]Fluorocholine PET\/CT in Assessment and Clinical Decision Making of Recurrent Prostate Cancer: A Prospective Crossover Trial"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3918-3812","authenticated-orcid":false,"given":"Mohsen","family":"Beheshti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malihe","family":"Shahbazi-Akbari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Hacker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Loidl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Werner","family":"Langsteger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"issue":"10","key":"2020_CR1","doi-asserted-by":"publisher","first-page":"811044","DOI":"10.3389\/fpubh.2022.811044","volume":"16","author":"L Wang","year":"2022","unstructured":"Wang L, Lu B, He M, Wang Y, Wang Z, Du L (2022) Prostate cancer incidence and mortality: global status and temporal trends in 89 countries from 2000 to 2019. 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