Prostate cancer (PCa) is biologically heterogeneous, requiring management strategies that balance oncologic benefit with preservation of quality of life. Prostate-specific membrane antigen (PSMA) has emerged as a key theranostic biomarker enabling highly sensitive molecular imaging and targeted therapy.
The present manuscript aims to summarize the clinical role of PSMA-PET/CT in PCa across staging, treatment selection, and response assessment, with a special focus on its contribution to personalized management.
PSMA-PET/CT demonstrates superior accuracy compared with conventional imaging, frequently leading to stage migration and changes in therapeutic strategy. It improves detection of metastatic and recurrent disease, guides selection for systemic and PSMA-targeted therapies, and supports metastasis-directed treatment in oligometastatic settings, potentially delaying androgen-deprivation therapy and preserving quality of life. Additionally, PSMA-PET enhances intra-prostatic lesion delineation for focal therapies and radiotherapy planning. Limitations include reduced sensitivity for very small lesions, possible false positives, variability among tracers, and issues related to access and standardization.
PSMA-PET/CT is a cornerstone of precision imaging in PCa, enabling more individualized treatment decisions across the disease continuum. Ongoing studies will further define its long-term clinical impact and integration into routine care.
Cancers. 2026 Jun 01*** epublish ***
Cesare Guida, Laura Evangelista, Marco Spadafora, Gaetano Facchini, Luigi Mansi
Radiotherapy Complex Unit, Ospedale del Mare, Azienda Sanitaria Locale Napoli 1 Centro, 80147 Napoli, Italy., Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy., Medicina Futura, 80143 Napoli, Italy., Oncology Complex Unit, Santa Maria delle Grazie Hospital, Azienda Sanitaria Locale Napoli 2 Nord, 80078 Pozzuoli, Italy., Interuniversity Research Center for Sustainability (CIRPS), 00038 Rome, Italy.