Evaluating [68Ga]-Ga PSMA PET/CT for Detecting Prostate Cancer Recurrence Post-High-Intensity Focused Ultrasound and Brachytherapy: A Single-Center Retrospective Study

Focal therapy offers a promising approach for treating localized prostate cancer (PC) with minimal invasiveness and potential cost benefits. High-intensity focused ultrasound (HIFU) and brachytherapy (BT) are among these options but lack long-term efficacy data. Patient follow-ups typically use biopsies and multiparametric MRI (mpMRI), which often miss recurrences. PET/CT with PSMA has emerged as a promising tool for detecting residual disease or recurrence post-treatment, offering higher sensitivity and specificity than traditional imaging. We retrospectively reviewed patients who underwent [68Ga]Ga-PSMA-11 PET/CT for biochemical recurrence (BCR) after HIFU or brachytherapy from 2016 to 2024. Out of 22 patients, 32% had HIFU and 68% had brachytherapy. The median time from treatment to PET scan was 77 months, with a median PSA level of 3 ng/mL. [68Ga]Ga-PSMA-11 PET/CT identified PC recurrence in 63.6% of cases. Of these, 50% showed prostate recurrence, 14% had lymph node involvement, and 28% had metastatic disease. Focal therapies like HIFU and brachytherapy are effective and minimally invasive options for localized PC. [68Ga]Ga-PSMA-11 PET/CT is valuable for detecting recurrence or residual disease, enhancing post-treatment surveillance.