PSMA PET/CT in contemporary prostate cancer management: From initial staging to biochemical recurrence.

ReviewHellenic journal of nuclear medicine· 2026

PSMA PET/CT in contemporary prostate cancer management: From initial staging to biochemical recurrence.

Emmanouil Panagiotidis, George Angelidis, Filippos Koinis … Panagiotis Georgoulias

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Oncologic ImagingReviewDiagnosisQ3IF 0.7

Prostate-Specific Membrane Antigen PET/CT far outperforms conventional imaging for primary prostate cancer staging accuracy.

PSMA PET/CT in contemporary prostate cancer management: From initial staging to biochemical recurrence.

Emmanouil Panagiotidis … Panagiotis Georgoulias

Hellenic journal of nuclear medicine · 2026 · Q3 in Radiology

Purpose

The objective of this review is to provide nuclear medicine physicians with a comprehensive and practical framework for Prostate-Specific Membrane Antigen PET/CT interpretation, structured reporting, and clinical decision integration, with emphasis on primary staging evidence, biochemical recurrence (biochemical recurrence) detection rates, imaging pitfalls, and the Prostate-Specific Membrane Antigen-RADS reporting system.

Methods

A narrative review of published evidence was performed, encompassing landmark randomised controlled trials and guideline documents from the EAU, EANM, and NCCN.

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Results

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Prostate-Specific Membrane Antigen scans read tumor extent far more accurately than standard imaging

More results

Detection rates in biochemical recurrence ranged from 38% at PSA <0.2ng/mL to 97% at PSA >2ng/mL.

In a phase 3 RCT, 18 F-PSMA-1007 demonstrated superiority over 18 F-Choline (84% vs 69%, OR 2.53, p<0.001).

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Conclusion · 1 of 2

Prostate-Specific Membrane Antigen PET/CT provides superior staging accuracy, enables detection of recurrence at low PSA levels, guides oligometastasis-directed therapy, and serves as the mandatory gatekeeper for 177 Lu-Prostate-Specific Membrane Antigen-617 theranostic eligibility.

Conclusion · 2 of 2

Structured reporting using Prostate-Specific Membrane Antigen-RADS and rigorous CT correlation - particularly to exclude unspecific bone uptakes (unspecific bone uptakes) with 18 F-Prostate-Specific Membrane Antigen-1007 - are core professional competencies of the nuclear medicine physician.

PSMA PET/CT in contemporary prostate cancer management: From initial staging to biochemical recurrence.

PSMA PET/CT in contemporary prostate cancer management: From initial staging to biochemical recurrence.

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