Superior Performance of 99m Tc-FAPI SPECT/CT Compared With 99m Tc-PSMA Scintigraphy in the Initial Staging of Prostate Cancer: A Case Report.

We present a case involving a 62-year-old man diagnosed with acinar-type prostate adenocarcinoma, who was referred for initial staging with 99m Tc-PSMA scintigraphy. Considering the metastatic lesions exhibited low PSMA avidity, a 99m Tc-FAPI-46 scintigraphy was conducted to improve the detection of metastases and to potentially facilitate future radio-ligand therapy using FAP-targeted radiopharmaceuticals. In this experience, 99m Tc-FAPI-46 demonstrated superior diagnostic performance compared with 99m Tc-PSMA scintigraphy, underscoring its potential utility in cases where tumors exhibit low PSMA expression or when tumor heterogeneity is suspected.