Impact of PSMA-Based Radiopharmaceuticals on the Clinical Management of Prostate Cancer.

BACKGROUND

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.

PURPOSE: 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.

KEY FINDINGS: 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.

CONCLUSIONS

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.