Role of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) in staging

The superiority of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) over conventional staging methods such as computed tomography (CT) and bone scintigraphy has now been demonstrated for almost all clinical stages of prostate cancer. In primary diagnostics, PSMA-PET/CT is therefore the new standard for risk-adapted whole-body staging. At the same time, PSMA-PET/CT provides a new risk-based classification for predicting overall survival across all early and late stages of the disease. However, the clinical implications of this information are not yet fully understood, particularly as data on systemic therapy for metastatic prostate cancer are still based on conventional imaging. For this reason, clinical follow-up is usually still carried out using conventional imaging. The Prostate Cancer Working Group 4 criteria will represent an initial consensus on therapy monitoring using PSMA-PET/CT. To monitor treatment response using PSMA PET/CT in metastatic castration resistant prostate cancer, there is already a framework (RECIP 1.0) in place. There is no doubt that PSMA PET/CT should be performed prior to PSMA radioligand therapy to optimize patient selection.