Abstract Purpose To compare the diagnostic performance of 18 FFDG and 18 FPSMA‑1007 PET/CT for detecting primary tumors, regional lymph node involvement, and distant metastases in recently diagnosed muscle‑invasive bladder cancer (MIBC). Methods Prospective single‑center cohort of six patients (ages 57–82). Both PET/CTs were acquired within 30 days under EANM/SNMMI-conformant protocols, with blinded consensus readings and post-diuretic pelvic acquisitions. Results 18 FPSMA‑1007 identified 15 lesions versus 14 with 18 FFDG. Primary bladder lesions were detected in 5 of 6 patients, compared to 3 of 6 patients. Both tracers detected nodal metastases in three patients and bone metastases in one. An 18 FFDG‑avid pulmonary lesion near the spleen was not detected with 18 FPSMA‑1007 owing to physiological splenic uptake. Conclusion Both tracers showed comparable sensitivity for metastatic disease. The hepatobiliary clearance of 18 FPSMA‑1007 improved visualization of intravesical disease, supporting its use in staging and potential theranostic strategies in selected MIBC patients. Such real-world findings inform refinements for future study procedures, logistics, and methodological design, which are essential for minimizing research waste by identifying potential problems early. Trial Registration: Not applicable. Graphical Abstract
Avilez et al. (Mon,) studied this question.