{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T17:15:38Z","timestamp":1783358138380,"version":"3.54.6"},"reference-count":37,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: This study aimed to determine whether incorporating radiologic contrast during the excretory (urographic) phase enhances the detection of recurrence on [68Ga]Ga-PSMA-11 PET\/CT in patients with biochemical relapse (BCR) following radical prostatectomy (RP). Methods: A single-center retrospective analysis included 43 men with BCR after RP who underwent [68Ga]Ga-PSMA-11 PET\/CT. Each patient underwent two comparative assessments. In the first assessment, whole-body PET images acquired at 60 min post-injection were fused with the non-contrast CT from early dynamic pelvic imaging (PET\/CTd), and local recurrence and pelvic nodal involvement were evaluated according to PROMISE V2 and E-PSMA frameworks by two blinded readers. In the second assessment, the same PET dataset was fused with the excretory-phase CT urography (CT-U) obtained during the same imaging session at 60 min post-injection, and the same parameters were re-evaluated. Endpoints included surgical-bed classification, peri-ureteric nodal status, reader confidence, ureter visualization\/opacification, and interpretation time. Inter- and intra-observer agreement was assessed, and discrepancies were resolved by consensus. Results: Surgical-bed positivity decreased from 12\/43 (27.9%) on PET\/CTd to 5\/43 (11.6%) on PET\/CT-U, leading to reclassification in seven patients (p = 0.016). Reader confidence improved significantly in five cases (p &lt; 0.005). Peri-ureteric nodal status was changed in four patients (two positive-to-negative and two negative-to-positive), with overall positivity unchanged (5\/43 vs. 5\/43; p = 1.000). Ureter visualization improved markedly (inadequate: 31 vs. 10 cases), reducing diagnostic uncertainty by 50%. CT-U opacification was \u226550% in most cases (\u03ba = 0.814), enabling reliable delineation of the ureteral course. Inter-reader agreement remained strong (surgical bed \u03ba: 0.944 vs. 0.876; nodes \u03ba: 0.896 both). Interpretation time decreased for both readers (senior: 3.12 vs. 2.10 min (\u221232.7%); junior: 4.06 vs. 2.42 min (\u221240.4%)). Conclusions: Adding an excretory-phase CT urography to [68Ga]Ga-PSMA-11 PET\/CT improves diagnostic confidence, reduces interpretive uncertainty in the surgical bed, clarifies peri-ureteric nodal findings, enhances ureter visualization, and shortens interpretation time. CT-U is a practical enhancement to low-dose PET\/CT protocols for BCR after RP.<\/jats:p>","DOI":"10.3390\/cancers18132171","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T16:20:39Z","timestamp":1783354839000},"page":"2171","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Head-to-Head Comparison of [68Ga]Ga-PSMA-11 PET Interpreted with Non-Contrast CT Versus Excretory-Phase CT Urography in Biochemical Recurrence of Prostate Cancer"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8875-5613","authenticated-orcid":false,"given":"Vicky","family":"Betech-Antar","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9791-6186","authenticated-orcid":false,"given":"Juan J.","family":"Rosales","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"M\u00ednguez","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Romera","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3493-7493","authenticated-orcid":false,"given":"Luis","family":"Fuertes","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"D\u00edez-Caballero","sequence":"additional","affiliation":[{"name":"Department of Urology, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7745-5650","authenticated-orcid":false,"given":"Bernardino","family":"Mi\u00f1ana-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Urology, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6285-4816","authenticated-orcid":false,"given":"Rafael","family":"Martinez-Monge","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar F.","family":"Guillen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9069-7918","authenticated-orcid":false,"given":"Macarena","family":"Rodr\u00edguez-Fraile","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Cl\u00ednica Universidad de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","first-page":"17","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J. 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