Background: A decision to treat prostate cancer (PC) with radical prostatectomy (RP) with curative intent requires confidence that the PC is confined to the prostate. PC outcomes will improve with better selection of surgical candidates. Current imaging modalities include CT and MRI but have limited accuracy. We assessed ¹⁸F-FDG (FDG) and ¹¹C-choline (CHOL) PET in men planned for RP to determine the accuracy of PET, effects of PET on decision making by surgeons, and correlation with PSA. Methods: Written informed consent was obtained from eligible participants (pts) planned for RP. All men underwent TRUS-guided prostatic biopsies, CT and MRI scans, PSA and standard tests of organ function. The urologist then documented the treatment plan based on these results. Pts then underwent FDG and CHOL PET and the urologist then determined whether this information altered the treatment plan. After surgery the RP specimen was reconstructed, examined histologically and correlated with TRUS and imaging results on a sextant-based analysis (apex/mid/base on both sides). Results: 30 pts entered and completed the trial. Outcomes are shown in the table. Neither PET modality significantly affected decisions about surgery. Preoperative PSA did not correlate with degree of involvement. FDG PET was unhelpful. Conclusions: CHOL PET was the most sensitive and most accurate modality with highest congruity with pathology and had excellent positive predictive value, but was least specific. CHOL PET was superior to both TRUS biopsy and MRI. Supported by grant 487916 through Cancer Australia, Prostate Cancer Foundation Australia, Australian Government Department of Health and Aging.