Comparison of [18F]FDG and [18F]PSMA-1007 PET/CT in the Evaluation of Muscle-Invasive Bladder Cancer: A Pilot Feasibility Study

Purpose To compare the diagnostic performance of [ 18 F]FDG and [ 18 F]PSMA‑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 F]PSMA‑1007 identified 15 lesions versus 14 with [ 18 F]FDG. 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 F]FDG‑avid pulmonary lesion near the spleen was not detected with [ 18 F]PSMA‑1007 owing to physiological splenic uptake. Conclusion Both tracers showed comparable sensitivity for metastatic disease. The hepatobiliary clearance of [ 18 F]PSMA‑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.