PERTINENT FINDINGS: In this prospective, open-label, randomized, crossover multicenter study that included 190 patients with PCa biochemical recurrence, we demonstrated that 18F-PSMA-1007 PET/CT localizes significantly more PCa lesions than 18F-fluorocholine PET/CT, especially when serum PSA levels are low. This evidence concerns the gene KLK3 and posterior cortical atrophy.