Advantages and Disadvantages of PSMA Imaging Modalities and PSMA-Targeted Endoradiotherapy
| Technique | Advantage | Disadvantage |
| PSMA scintigraphy (99mTc-MIP-1404) | Primary tumor: higher sensitivity than MRI | Lower spatial resolution than PET |
| Prospective trials are available | Slower pharmacokinetics than 68PSMA-11 PET | |
| Less expensive than PET | Value in recurrent disease has not yet been analyzed | |
| Broad availability is expected in future | ||
| PSMA ligand PET/CT (68Ga-PSMA-11) | Multiple publications are available | With one exception, only retrospective analyses are available |
| Most available PSMA imaging modality worldwide | ||
| PSMA ligand PET/MRI (68Ga-PSMA-11) | High diagnostic value in soft tissue, including primary tumor | Expensive |
| Long scanning time | ||
| Extinction artifacts around urinary bladder | ||
| Only retrospective analyses are available | ||
| PSMA-targeted endoradiotherapy | Independent from androgen receptors | Limited data, only retrospective analyses available |
| No cross-resistance with zytiga/enzalutamide/docetaxel is expected | Long-term side effects are unknown | |
| Early data show good response of PCa lesions | No comparison of different ligands is available | |
| Endoradiotherapy with 131I | Lower kidney dose | Hospitalization (5–10 d) |
| More effective in large tumor lesions than 177Lu | Bone marrow dose | |
| Radiolabeling procedure | ||
| Endoradiotherapy with 177Lu | Easier radiolabeling than with 131I | Higher kidney dose than 131I |
| Short hospitalization (2 d) | ||
| Endoradiotherapy with 225Ac | Highest therapeutic effect due to α-radiation | Available at a single center worldwide |
| Experimental | ||
| Expensive |