Impact of Routine PSMA PET/CT Imaging on Prostate Cancer Management: A Multidisciplinary Perspective

Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is quickly becoming a transformative tool in prostate cancer management. As it gains traction in clinical settings, a multidisciplinary panel comprising experts in urology, radiation oncology, nuclear medicine, and medical oncology reviewed its current and future implications in European Urology Open Science.

PSMA PET/CT now plays a key role in both the initial staging of prostate cancer and in detecting biochemical recurrence, offering significantly improved sensitivity and specificity compared to traditional imaging techniques. Supported by pivotal studies like proPSMA and OSPREY, PSMA PET/CT has demonstrated superior performance, particularly for high-risk patients and those with low PSA levels.

Its widespread use is already altering treatment decisions. For newly diagnosed patients, PSMA PET/CT helps more accurately identify nodal involvement or distant metastasis. This level of precision often results in changes to the therapeutic approach. For example, patients who may have been candidates for localized curative treatment might instead receive systemic therapy if PSMA PET/CT reveals additional disease sites.

In the context of biochemical recurrence—where PSA levels rise post-treatment but conventional imaging fails to locate disease—PSMA PET/CT proves especially valuable. It often identifies previously undetectable metastases, which enables more personalized treatment planning, whether through salvage radiation, systemic therapy, or inclusion in clinical trials.

However, the panel also cautioned against overreliance on imaging alone. Interpretation must be contextualized within each patient’s clinical profile. Discrepancies between imaging results and other risk factors can complicate decision-making, and the need for clinician education around scan interpretation was emphasized.

Standardization remains a concern as well. Variability in how PSMA PET/CT scans are read across institutions can impact treatment consistency. Additionally, despite its growing use, access to the technology is not uniform. While some regions have broad availability, others face limitations due to cost and healthcare system adoption lags.

Still, the consensus is that PSMA PET/CT is a game-changer. It enables earlier and more precise detection, supports better triage, and contributes to more individualized treatment planning. As clinical guidelines continue to evolve to include PSMA PET/CT, multidisciplinary collaboration will be essential in integrating the technology effectively and responsibly into routine prostate cancer care.