The Role of PSMA PET Imaging in the Classification of the Risk of Prostate Cancer Patients: A Systematic Review on the Insights to Guide an Active Surveillance Approach

Simple Summary The prognosis of prostate cancer (PCa) patients and their best therapeutic approach are related to the risk-based classification of this neoplasm since subjects with higher risk could have a higher incidence of recurrence. In addition, patients with low- and intermediate-risk PCa could benefit from active surveillance (AS). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging has demonstrated its value for the assessment, prognostic role, and ability to guide the therapy of PCa. The aim of this systematic review was to assess the role of PSMA PET in guiding the correct classification of low-to-intermediate risk PCa subjects and the AS approach. Insights on the value of this imaging modality in these settings have emerged; however, further research in this field is necessary to clearly define the role of PSMA PET.Abstract Background: active surveillance (AS) is a suitable strategy for patients with prostate cancer (PCa). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging is an established tool used to assess PCa. The aim of this review was to evaluate the role of PSMA imaging to guide correct risk-based classification and the AS approach in PCa patients. Methods: The Scopus, Embase, Web of Science, Cochrane Library, and PubMed/MEDLINE databases were screened to find relevant published articles. Results: 1774 articles were revealed with the literature search. A total of 1764 articles were excluded after applying exclusion criteria (data not within the field of interest, preclinical papers, conference proceedings, reviews, or editorials). Ten studies were finally included in the review, revealing that PSMA PET could have the ability to guide risk-based classification of PCa and the choice of AS, and to guide the execution of biopsies for the research of high-grade PCa, therefore precluding AS. Conclusion: this systematic review underlined a possible role of PSMA PET imaging in patients with PCa by correctly re-classifying them on the basis of their risk and guiding AS.