Nuclear Center Research Articles

Production and radiochemical separation of 68Ge from irradiated Ga–Ni alloy target in 30 MeV cyclotron

Abstract Gallium-68 [t 1/2: 67.7 min, β+ (89 %)] has application in PET imaging mainly for prostate cancer and neuroendocrine tumours. Gallium-68 is generally obtained from a 68Ge/68Ga generator. It is therefore an important task to prepare 68Ge (t 1/2 = 271 days) radiochemical for the manufacture of 68Ge/68Ga generator to cater for the needs of various nuclear medicine centres. Germanium-68 has been produced successfully after irradiation of indigenously developed Ga–Ni targets in a 30 MeV cyclotron and chemical processing of the irradiated targets using an indigenous semi-automated module. The Ga–Ni targets were prepared by an electroplating method. The 68Ge has been radiochemically separated from irradiated Ga–Ni targets using Sephadex G-25 column chromatography. The chemical separation yield and radionuclidic purity of 68Ge were about 70 % (n = 3) and about 98.3 % (n = 3), respectively.

Multilayer radiation shields for nuclear and radiological centers using free-lead materials and nanoparticles

We prepared two types of lead-free shielding materials consist of double and triple layered with different thicknesses and reported the radiation shielding performance of the developed concrete samples. The linear attenuation coefficient (LAC) of microcomposites was calculated theoretically by XCOM-software and compared with experimental results and less than 4 % difference was observed at all discussed energies. We measured the half and tenth value layers (HVL and TVL) of the single, double and triple layered samples and evaluated the radiation shielding efficiency (RSE) at different energies. The experimental data showed that the inclusion of nanoparticles into the composites reduced the TVL. The triple layered sample, composed of a 3 cm IM-2 layer, a 15 cm CON-2 layer, and a 2 cm IM-2 layer, exhibited exceptional radiation shielding performance, with an RSE of 97.5 % at 0.662 MeV, and an RSE of approximately 92 % for energies greater than 1 MeV. Comparing our samples to pure lead, we found that our double and triple layered samples could replace lead in practical applications, with the triple layer exhibiting superior performance at energies greater than 0.662 MeV. The RSE of our triple layered sample was 100 % for energies less than 0.06 MeV and 97.5 % at 0.662 MeV, and the RSE of our double layered sample with a thickness of 18 cm was 93.5 % and 92.3 % for energies of 1.173 and 1.33 MeV, respectively.

Structural Insights into the Reaction between Hydrogen Peroxide and Di-iron Complexes at the Ferroxidase Center of Ferritin.

The Fe(II) oxidation mechanism in the ferroxidase center of heavy chain ferritin has been studied extensively. However, the actual production of H2O2 was found to be substantially lower than expected at low flux of Fe(II) to ferritin subunits. Here, we demonstrated that H2O2 could interact with the di-iron nuclear center, leading to the production of hydroxyl radicals and oxygen. Two reaction intermediates were captured in the ferroxidase center by using the time-lapse crystallographic techniques in a shellfish ferritin. The crystal structures revealed the binding of H2O2 as a μ -1,2-peroxo-diferric species and the binding of O2 to the diferric structure. This investigation sheds light on the reaction between the di-iron nuclear center and H2O2 and provides insights for the exploitation of metalloenzymes.

Spatiotemporal DNA methylation dynamics shape megabase-scale methylome landscapes.

DNA methylation is an essential epigenetic mechanism that regulates cellular reprogramming and development. Studies using whole-genome bisulfite sequencing have revealed distinct DNA methylome landscapes in human and mouse cells and tissues. However, the factors responsible for the differences in megabase-scale methylome patterns between cell types remain poorly understood. By analyzing publicly available 258 human and 301 mouse whole-genome bisulfite sequencing datasets, we reveal that genomic regions rich in guanine and cytosine, when located near the nuclear center, are highly susceptible to both global DNA demethylation and methylation events during embryonic and germline reprogramming. Furthermore, we found that regions that generate partially methylated domains during global DNA methylation are more likely to resist global DNA demethylation, contain high levels of adenine and thymine, and are adjacent to the nuclear lamina. The spatial properties of genomic regions, influenced by their guanine-cytosine content, are likely to affect the accessibility of molecules involved in DNA (de)methylation. These properties shape megabase-scale DNA methylation patterns and change as cells differentiate, leading to the emergence of different megabase-scale methylome patterns across cell types.

Contre-utopie et utopie dans Méridien zéro de Mourareau

Mourareau’s novel Méridien zéro (2020) depicts a counter-utopia in coexistence with an emblematic collective utopia: Tahiti and her enchanted islands. In the first part of the novel, the wanderings of the two protagonists, Rose and Bleu, project the reader into the near future of a world falling apart. The « social Eurocraties » have been unable to prevent civilizational collapse and Europe is crumbling. Through a somewhat unconventional lens and line of argument, the author bolsters the indictment first made by the earliest Polynesian writers to prosecute, in the court of capital-H History, the notions of progress advanced by Western societies. It is indeed Western civilization and the failure of its ideologies that are displayed here in a context of general decadence. It is thus toward Tahiti and her islands that the characters turn to change their lives, but the capitalistic logics that reign there since the Centre d’Expérimentation du Pacifique—a nuclear testing center—and the acculturation that has resulted from colonization on political, economic and religious levels render the island an uninteresting space for them. The island of Raroia will perhaps provide them with the new civilizational paradigm to which they aspire.

Evaluating internal exposure due to intake of 131I at a nuclear medicine centre of Dhaka using bioassay methods

Handling of radioisotopes may cause external and internal contamination to occupational workers while using radiation for medical purposes. This research aims to monitor the internal hazard of occupational workers who handle 131I. Two methods are used: in vivo or direct method and in vitro or indirect method. The in vivo or direct method was performed by assessing thyroid intake with a thyroid uptake monitoring machine. The in vitro or indirect method was performed by assessing urine samples with the help of a gamma-ray spectroscopy practice using a High-Purity Germanium (HPGe) Detector. In this study, fifty-nine thyroid counts and fifty-nine urine samples were collected from seven occupational workers who were in charge of 131I at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka. The result showed that the average annual effective dose of seven workforces from thyroid counts were 0.0208 mSv/y, 0.0180 mSv/y, 0.0135 mSv/y, 0.0169 m Sv/y, 0.0072 mSv/y, 0.0181 mSv/y, 0.0164 mSv/y and in urine samples 0.0832 mSv/y, 0.0770 mSv/y, 0.0732 mSv/y, 0.0693 mSv/y, 0.0715 mSv/y, 0.0662 mSv/y, 0.0708 mSv/y.The total annual effective dose (in vivo and in vitro method) was found among seven workers in average 0.1039 mSv/y, 0.0950 mSv/y, 0.0868 mSv/y, 0.0862 mSv/y, 0.0787 mSv/y, 0.0843 mSv/y, 0.0872 mSv/y. Following the rules of the International Commission on Radiological Protection (ICRP), the annual limit of effective dose for occupational exposure is 20 mSv per year and the finding values from this research work are lesser than this safety boundary.

Experimental Study of the Compressibility of a Helium Plasma at a Pressure up to 20 TPa

A nonideal helium plasma has been compressed to a density of ρ ≈ 14 g/cm3at a pressure ofP≈20TPa (200Mbar) in a spherical two-cascade device. The design of the device has been presented and the thermodynamic parameters of the helium plasma reached in it have been estimated. Data on the dynamics of the external and internal cascades in the device used to choose the calculation method have been obtained in a preliminary experiment with a hemispherical prototype. The experiment has been performed on the X-ray complex at the Russian Federal Nuclear Center All-Russian Research Institute of Experimental Physics, which includes BIM 234.3000 betatrons with a boundary energy of 60 MeV used in the multipulse bremsstrahlung generation regime with a multichannel optoelectronic system of recording X-ray images. A high-current linear accelerator LIU-R-T and an image detector assembly consisting of photochromic ADC screens have been used in addition to betatrons to detect the compressed shell cavity.

Impaired myocardial flow reserve from 82-rubidium positron emission tomography predicts survival benefit from revascularization: a multicenter registry study

Abstract Background The identification of patients that may accrue prognostic benefit from revascularization is complex. Myocardial perfusion imaging (MPI) using 82-rubidium positron emission tomography (82Rb-PET) provides information on myocardial perfusion defects, calcium-score, left ventricular ejection fraction (LVEF), and myocardial flow reserve (MFR). Purpose To examine if MFR assessed by 82-Rb PET MPI identifies subgroups that benefit from revascularization. Methods We included 7462 all-comers suspected of coronary artery disease undergoing 82-Rb-PET MPI at three high-volume nuclear centers in Denmark between January 1, 2018, and August 20, 2020. Patients with reversible perfusion defects <5%, eGFR <30 mL/min/1.73m2, receiving dialysis, left ventricular ejection fraction <35%, and those that died within 90 days of their index 82Rb-PET MPI were excluded. Revascularization was defined as percutaneous coronary intervention (PCI) or coronary artery bypass-graft surgery (CABG) within 90 days of MPI. Patients were followed for major adverse cardiac events (MACE), a composite of all-cause death, acute coronary syndromes, ischemic stroke, or heart failure, and all-cause mortality until July 9, 2022. We analyzed each outcome according to revascularization and MFR (<2 vs. ≥2) using the Kaplan-Meier estimator and proportional hazards Cox regressions adjusted for patient and 82Rb-PET characteristics, including any perfusion defects, using inverse probability weighting. Results A total of 1805 patients were included (mean age 69 (SD 10.6), 29.8% females, 27% diabetes), of whom 902 (50%) had MFR <2. The median follow-up was 35.9 months. A total of 480 were revascularized. 58 experienced a MACE; 36 died. Revascularization was associated with a significantly lower risk of all-cause mortality and MACE among patients with MFR<2, whereas there was no survival benefit from revascularization among those with normal MFR (figure 1). After adjustment, HR for revascularization for MACE in the MFR<2 group was 0.51 (95%CI 0.33-0.78) versus 1.19 (95%CI 0.64-2.20) in the MFR>=2 group (p for interaction 0.042) and for All-cause mortality 0.48 (95%CI 0.30-0.77) in the MFR<2 group versus 1.01 (95%CI 0.43-2.39) in the MFR>=2 group (p for interaction 0.28). Results were independent of the extent of reversible perfusion defect, consistent across several subgroups, and independent of the mode of revascularization (CABG or PCI), figure 2. Conclusion In this observational study, revascularization was associated with improved prognosis, specifically among patients with impaired MFR, whereas among patients with normal MFR, there was no prognostic benefit. Impaired MFR may identify patients with prognostic benefit from revascularization. This novel hypothesis should be tested in a randomized controlled trial.Kaplan MeierForest plot

Know-why? and know-how? in the development of nuclear talents: An analysis of recent nuclear engineering Ph. D. research

The relationship between the industry and academia is widely considered the key driver or obstacle in producing and using new knowledge. This is, at least in part, a consequence of different forms of knowledge being of different utility for the industry and academia (conceptual, e.g., why? and procedural, e.g., how?). In so-called “high-tech” industries, where the attraction and development of new talents are in significant part carried out through academic research-based higher education system, successful cooperation in the development of new knowledge automatically results in successful attraction and development of new talents. In well-established, strongly regulated, and very procedural industries, such as nuclear power, the pragmatic focus on procedural over conceptual knowledge may also result in the pathways of talent development outside of the research-based higher education system. Some definitions, features, and risks of different approaches to conceptual and procedural knowledge are outlined and discussed in the paper and an attempt is made to connect them with the notions of basic and applied research. It is suggested that suitable sequences and balance of know-why? and know-how? may lead to the best results in the attraction and development of new nuclear talents, while minimizing the risks of reduced ability to manage unexpected, reduced need for innovation and weakening the nuclear knowledge centers outside of the industry and regulators. This is supported by an analysis of 51 Ph.D. theses in nuclear engineering developed in Slovenia since 1993 to discern their contributions towards basic or applied research. The Pasteur’s quadrant, developed by (Stokes, 1997), was used as the underlying framework. Ph.D. graduates and supervisors were independently asked to evaluate the basic and applied contributions through three variables, describing the stages of the creative research process: input, processing, and output, respectively. The predominantly mixed (basic and applied) contributions of the analyzed Ph.D. theses indicate that academic nuclear engineering education is an enabler of successful careers in academia and industry.

Information and analytical system as a promising database used to justify the safety of nuclear energy

This work is devoted to the creation of an information and analytical system (hereinafter - IAS), which is being developed to manage data obtained in experiments and researches to justify the safety of atomic energy, which have been conducted at the National Nuclear Center of the Republic of Kazakhstan for over 30 years. The main components of the IAS, which determines its consumer capabilities, is an analytical unit that will allow creating programs for planned experiments based on technical requirements to them and based on the results of previous experiments, generalized and consolidated by processing and comparison tools provided by the IAS. The analytical block of the information and analytical system provides opportunities for processing experimental information using various methods - graphical, computational, statistical and others.The information and analytical system are able to work on different platforms and support different interface languages for stored data, which makes it potentially interesting for use in different environments and for different users. The information and analytical system are based on the Microsoft SQL Server platform, the software is implemented in the Microsoft Visual Studio ASP.NET Core Blazor development environment.

Sacroiliac Joint Index in Healthy Pakistani Population and Patients with Sacroiliitis Using Technetium-99m Methylene Diphosphonate Bone Scintigraphy

Objective: To determine the values of the Sacroiliac Joint Index (SI Index) in normal population and patients with sacroiliitis (SI) and the correlation of normal values with age and gender. Study Design: Prospective longitudinal study. Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Dec 2020 to Jul 2022. Methodology: A total of 140 patients (Group-I consisting of 129 cancer patients having no clinical or radiological evidence of SI referred for metastatic/staging workup and Group-II consisting of 11 patients with clinical, laboratory and radiological diagnosis of ankylosing spondylitis) who underwent whole body bone scintigraphy using Technetium Pertechnetate (Tc-99m) labelled Methylene Diphosphonate (MDP) were included. The SI Index was calculated for each patient using the sacroiliac joint (SIJ) to sacrum radiotracer uptake ratio using the ROI method. Results: The mean SI Index was 1.02±0.09, (range: 0.87-1.24) in normal individuals while 1.28±0.09 (range: 1.15-1.53) in patients with SI. A significant statistical difference was observed in both groups for the SI Index (p-<0.001). In addition, the SI Index was significantly associated with age (p=0.016) in the normal population. Conclusion: The SI Index quantification using bone scintigraphy is a sensitive and cost-effective method for detecting SI. In addition, the SI Index differs according to age, so a different cut-off value should be used for each group.

Experimental Study of the Compressibility of a Helium Plasma at a Pressure up to 20 TPa

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A novel micron europium cluster coordination polymer as a strong electrochemiluminescent emitter for accurate and sensitive detection of tetracycline.

In this work, a self-luminescent micron europium cluster coordination polymer (Eu-CCP) cathode electrochemiluminescence (ECL) emitter is first reported. The mass percentage of Eu in Eu-CCP is 50.1%, indicating that Eu-CCP has a high-nucleation luminescence center. In addition, our Eu-CCP possesses a stable and efficient ECL red emission performance, and the intensity is approximately 6.5-fold higher than that of the traditional tris(2,2'-bipyridyl)ruthenium(II) dichloride. The enhancement of Eu-CCP luminescence in our system is due to the following reasons: (1) the mixed ligand and high nuclear europium luminescent center can cooperate to improve the quenching effect induced by water or hydroxyl groups; and (2) external coreaction accelerator and coreactant enhancement. We also investigate the application of Eu-CCP in ECL sensors by sensitive detection of tetracycline (TC). The low detection limit (73.5 fmol·L-1), high selectivity, good stability and satisfactory recoveries indicate that our ECL strategy can be used to detect TC accurately and sensitively.

О возможности модернизации подвижных катушек электродинамических вибростендов

Currently, testing products for vibration strength and vibration resistance became much more complicated, since the mass of test objects increased, vibration modes (including vibration shocks) are of more complex nature, and, as a result, the equipment operates at the maximum modes and fails. The most complex malfunction that occurs during prolonged hard work of the vibration stand is the breakdown of a moving coil, which repair, as a rule, is possible only in the specialized centers. The paper considers design of a regular moving coil of the high-power vibration stand and indicates its disadvantages. A modernized design of the moving coil is proposed increasing its strength, as well as a device for winding it, which provides necessary tension of the conductor during winding and turning the fiberglass frame. Results of operation of the vibration units with modernized coils are presented, capabilities of the Russian Federal Nuclear Center --- Zababakhin All-Russia Research Institute of Technical Physics in terms of modernizing the vibration stands of various traction forces and structures during repair of the moving coils are indicated. Conclusion is made on the advantages of the modernized moving coils

Monte Carlo simulation of the passive neutron multiplicity counting system

The neutron multiplicity counting (NMC) technique is a reliable method for quantifying special nuclear material (SNM). Simulations of these NMC instruments using the Monte Carlo codes can aid in improving and redesigning these instruments. The Geant4 toolkit can provide multiplicity distribution information for spontaneous fission events and can be used to determine the mass of plutonium material. This study constructed a complete passive neutron multiplicity counting (PNMC) system model to verify this capability for the Geant4. The performance parameters extracted from the simulation were compared to the experiments performed using a plutonium scrap multiplicity counter (PSMC) at the State Nuclear Security Technology Center (SNSTC). The comparison results indicated the validated accuracy and reliability of the Geant4 toolkit in PNMC studies, despite slight deviations from simulation results. The difference in moment distribution between the R+A- and A-gate exerts a strong influence on the multiplicity counting rate, particularly to double and triple neutron events. Therefore, variations in moment distributions resulting from source and counter modeling may be major contributing factors to bias in the results. Furthermore, variations in the SNM geometry will result in different self-shielding and multiplication effects, while different positions of the SNM will change the detection efficiency of the counter. However, these effects will ultimately manifest as a change in the multiplicity count rate.

The Development of Speaking and Singing in Infants May Play a Role in Genomics and Dementia in Humans.

The development of the central auditory system, including the auditory cortex and other areas involved in processing sound, is shaped by genetic and environmental factors, enabling infants to learn how to speak. Before explaining hearing in humans, a short overview of auditory dysfunction is provided. Environmental factors such as exposure to sound and language can impact the development and function of the auditory system sound processing, including discerning in speech perception, singing, and language processing. Infants can hear before birth, and sound exposure sculpts their developing auditory system structure and functions. Exposing infants to singing and speaking can support their auditory and language development. In aging humans, the hippocampus and auditory nuclear centers are affected by neurodegenerative diseases such as Alzheimer's, resulting in memory and auditory processing difficulties. As the disease progresses, overt auditory nuclear center damage occurs, leading to problems in processing auditory information. In conclusion, combined memory and auditory processing difficulties significantly impact people's ability to communicate and engage with their societal essence.

Scintigraphie osseuse monophotonique : quelle place dans la prise en charge du cancer de la prostate ?

Bone scintigraphy (SO) with bisphosphate labeled with 99mTc remains indicated in the guidelines for the detection of bone metastases before treatment of intermediate risk and high risks of recurrence prostate cancers (PC). SO remains also indicated in the evaluation of response to treatment of metastatic bone disease. Its main advantages are its availability, as it is performed routinely in all nuclear medicine centers in France, and very high performances, since whole-body Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) hybrid tomoscintigraphy almost systematically completes whole-body scanning. We propose in this article to review this technique at all clinical stages of CP.

Pain Outcomes in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with 223Ra: PARABO, a Prospective, Noninterventional Study.

223Ra, a targeted α-therapy, is approved for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) who have bone metastases. In the phase 3 ALSYMPCA study, 223Ra prolonged survival and improved quality of life versus placebo. Our real-world study, PARABO, investigated pain and bone pain-related quality of life in patients with mCRPC and symptomatic bone metastases receiving 223Ra in clinical practice. Methods: PARABO was a prospective, observational, noninterventional single-arm study conducted in nuclear medicine centers across Germany (NCT02398526). The primary endpoint was a clinically meaningful pain response (≥2-point improvement from baseline for the worst-pain item score in the Brief Pain Inventory-Short Form). Results: The analysis included 354 patients, who received a median of 6 223Ra injections (range, 1-6). Sixty-seven percent (236/354) received 5-6 injections, and 33% (118/354) received 1-4 injections. Of 216 patients with a baseline worst-pain score of more than 1, 59% (128) had a clinically meaningful pain response during treatment. Corresponding rates were 67% (range, 98/146) with 5-6 223Ra injections versus 43% (range, 30/70) with 1-4 injections, 60% (range, 60/100) in patients with no more than 20 lesions versus 59% (range, 65/111) in those with more than 20 lesions, and 65% (range, 69/106) in patients without prior or concomitant opioid use versus 54% (range, 59/110) in those with prior or concomitant opioid use. Mean subscale scores (pain severity and pain interference) on the Brief Pain Inventory-Short Form improved during treatment. Conclusion: 223Ra reduced pain in patients with mCRPC and symptomatic bone metastases, particularly in patients who received 5-6 injections. The extent of metastatic disease did not impact pain response.

Use of attr cardiac amyloidosis imaging in latin america

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with high morbidity and mortality(1). Non-invasive imaging techniques and novel treatments allow for a better prognosis, but a lack of clinical awareness of the proper use of imaging delays appropriate diagnosis and management. Since 2019, when the multi-society expert consensus on recommendations for multimodality imaging in cardiac amyloidosis (2) was published, multiple international societies have also published their position (3) making imaging techniques such as nuclear medicine scintigraphy (NMS), cardiac magnetic resonance (CMR) and transthoracic echocardiogram (TTE) the methods of choice for the diagnosis of ATTR-CM. Purpose We aim to know how non-invasive imaging methods are used to diagnose ATTR-CM in Latin America (LA) Methods Anonymous online surveys were distributed digitally among clinicians across LA for two months (June-July 2021). We asked about the availability and use of non-invasive cardiac imaging techniques to diagnose ATTR-CA. The information was automatically entered into a spreadsheet for tabulation and descriptive statistical analysis (Microsoft Excel 2016). Results Surveys were collected from 82 NM centers and 406 clinicians (mainly cardiologists, 65%), with responses from professionals from 17 of the 20 LA countries. The diagnostic image most available among the respondents was NMS (100%), followed by TTE ( 86%), and the last, CMR (76%). Fig 1. All nuclear medicine centers have access to perform SPECT acquisition, but advanced technology is lacking in some areas (SPECT/CT-44%, CZT-7%). Of the available phosphonates, PYP is accessible in most centers (83%); a minority use HMPD (12%), and just four centers use MDP (5%). Regarding TTE availability, only 59% can perform advanced techniques as GLS. Something similar happens in the availability of CMR since only 42% have access to advances sequences as mapping. When we presented a clinical scenario of a patient with a suspicious ETT of ATTR-CM, the following main study to request was CMR (43%), and only 38% considered NMS as the next one. 65% of the clinician's responders had not ordered a single NMS during the year before the survey. Of the remaining 35% who had requested the procedure, 27% had ordered 1–5 studies, and only 4% more than 10. The five countries where more NMS are acquired are Brazil, Argentina, Chile, Colombia, and Mexico. Fig 2. Conclusion(s) We present a representative sample of what happens in LA regarding the use of non-invasive imaging to diagnose ATTR-CM. Essential diagnostic imaging resources are reasonably available in the region but are under-utilized, probably because of the limited awareness of clinicians. Advance technology such as SPECT/CT, CZT, strain, and mapping are lacking; investment in technological infrastructure is needed. The survey demonstrated the need for educational programs to increase the utilization of diagnostic imaging in ATTR-CM.

Patterns of recurrence post prostatectomy in the PSMA era: What lessons can we take to daily practice from a high-volume nuclear medicine center?

e17013 Background: PSMA has deeply modified the treatment of prostate cancer, mainly in the biochemical recurrence setting, where the therapeutic plan may be changed in up to two thirds of cases. Unfortunately, this diagnostic tool is still not fully available in many places over the world. Growing evidence from high-volume nuclear medicine centers may guide the development of adapted treatment plans based on sites of relapse according to wide available clinical information. Methods: We retrospectively reviewed 648 Ga68-PSMA-PET-CT scans in the biochemical relapse setting in patients initially treated with prostatectomy. Results were classified either as negative or positive if abnormal SUV uptake was detected in the prostate bed, pelvis, or distant organs. We then classified the patients with positive tests based on sites of relapse according to serum PSA level. Results: Among the 648 analyzed patients, there were 60, 63, and 61 recurrences in prostate bed, pelvis, or distant organs, respectively. For those with serum PSA ≤ 1.0 ng/mL, there was a higher chance of locoregional failure (prostate bed or pelvis), with less than 20% presenting distant metastasis. When assessing patients with serum PSA 1.1-2.0 ng/mL, the rate of distant metastasis increased to 22.7%, while it was found in 40.7% of patients with serum PSA between 2 and 5 ng/mL. Conclusions: PSMA-PET-CT scan is clearly modifying the therapeutic landscape of prostate cancer in different scenarios. Although it is not available in many regions due to high financial costs and logistic barriers, the emerging evidence arising from specialized cancer centers matching the clinical information with tests results may help doctors to make better treatment decisions even without PSMA-PET-CT scans. [Table: see text]