Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computed tomography (CT), and whole-body magnetic resonance imaging (WB-MRI) are superior to conventional CT and bone scan imaging for detecting metastatic disease in patients with prostate cancer.
While these higher-accuracy imaging methods have already shown the potential to enhance patient outcomes, a thorough understanding of the relationship between the treatment landscape and disease volume on conventional imaging, as well as the prognostic significance of the prostate-specific antigen response, is crucial for determining how they can be more effectively incorporated. Prospective clinical trials are required to evaluate whether PSMA-PET/CT and WB-MRI can genuinely improve clinically relevant endpoints for patients through precise treatment adaptations. In this paper, we explore the specific opportunities of PSMA-PET/CT and WB-MRI as biomarkers in multiple clinical domains, including metastasis detection and staging, disease characterisation and aggressiveness assessments, biopsy target selection, impacts on treatment planning, evaluation of therapeutic response, and theranostics. We highlight the central research questions that require attention. KEY POINTS: Question Can PSMA-PET/CT and WB-MRI, with their superior ability to detect metastases in prostate cancer, truly improve patient outcomes? Findings High-accuracy imaging improves metastasis detection, staging, assessment of disease aggressiveness, and enables more personalised treatment planning for advanced prostate cancer patients. Clinical relevance PSMA-PET/CT and WB-MRI have the potential to alter the management of men with advanced prostate cancer, but prospective clinical trials are needed to confirm benefits for survival or quality of life before recommending routine use.
European radiology. 2025 Nov 05 [Epub ahead of print]
Sungmin Woo, Luca Russo, Samuel J Withey, Ailin Dehghanpour, Roberto García-Figueiras, Ivo G Schoots, Giuseppe Petralia, Amish Lakhani, Tobias Penzkofer, Martina Pecoraro, Chen-Jiang Wu, Jochen Walz, Matthias Eiber, Wolfgang P Fendler, Silke Gillessen, Raquel Perez-Lopez, Frédéric E Lecouvet, Tara D Barwick, Anwar R Padhani, ESUR Prostate MRI Working Group
Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Dipartimento Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK., Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy., Department of Radiology, Oncologic Imaging, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain., Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Division of Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Radiology, Mount Vernon Cancer Centre, Paul Strickland Scanner Centre, Northwood, UK., Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany., Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China., Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France., Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany., Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany., Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland., Radiomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain., Department of Medical Imaging, Institut de Recherche Expérimentale et Clinique, Institut du Cancer Roi Albert II, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium., Department of Radiology, Charing Cross Hospital, Imperial College Health Care NHS Trust, London, UK., Department of Radiology, Mount Vernon Cancer Centre, Paul Strickland Scanner Centre, Northwood, UK. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41193908