Bridging the Imaging Gap: PSMA PET/CT Has a High Impact on Treatment Planning in Prostate Cancer Patients with Biochemical Recurrence-A Narrative Review of the Literature

J Nucl Med. 2019 Oct;60(10):1394-1398. doi: 10.2967/jnumed.118.222885. Epub 2019 Mar 8.


68Ga- and 18F-labeled prostate-specific membrane antigen (PSMA) molecules have created new opportunities for the unmet diagnostic needs in prostate cancer. The purpose of this article is to give an overview of studies that have examined the role of PSMA PET in treatment planning for prostate cancer patients with biochemical recurrence (BCR). Methods: Medline, Embase, Web of Science, Google Scholar, and Cochrane Central were searched for relevant articles. After excluding the articles that did not fulfill the required criteria, we included in this review 12 publications that reported the impact of PSMA PET on the treatment plan for prostate cancer patients with BCR. Results: All studies in our review emphasized the impact of PSMA PET images on therapy management in prostate cancer patients with BCR. Overall, the impact of PSMA PET/CT on therapy management varied between 30% and 76% among the 1,346 patients included in the review. Upstaging was reported in 32%-67% of the patients. Patients with low prostate-specific antigen values (<0.5 ng/mL) also demonstrated positive lesions, which could not have been detected by means of conventional imaging techniques. Important modifications to the original treatment plan included avoidance of systemic therapy (17%-40%) and PET-directed local therapy (in ≤60% of the patients). Conclusion: PSMA imaging demonstrated a high clinical impact in patients with BCR, with modifications to the original treatment plan occurring among half the patients. Detecting recurrence in BCR can prevent unnecessary toxicity and lead to individualized therapy.

Keywords: 18F-PSMA; 68Ga PSMA; biochemical recurrence; prostate cancer; therapy impact.

Publication types

  • Review

MeSH terms

  • Antigens, Surface / metabolism*
  • Disease-Free Survival
  • Fluorine Radioisotopes / pharmacology*
  • Glutamate Carboxypeptidase II / metabolism*
  • Humans
  • Male
  • Membrane Glycoproteins / pharmacology*
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Organometallic Compounds / pharmacology*
  • Positron Emission Tomography Computed Tomography*
  • Prognosis
  • Prostate-Specific Antigen / metabolism
  • Prostatic Neoplasms / diagnostic imaging*
  • Prostatic Neoplasms / psychology
  • Prostatic Neoplasms / therapy
  • Quality of Life
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Research Design
  • Treatment Outcome


  • Antigens, Surface
  • Fluorine Radioisotopes
  • Membrane Glycoproteins
  • Organometallic Compounds
  • FOLH1 protein, human
  • Glutamate Carboxypeptidase II
  • Prostate-Specific Antigen
  • Fluorine-18
  • Glu-NH-CO-NH-Lys-(Ahx)-((68)Ga(HBED-CC))