PSMA PET imaging in localized prostate cancer and biochemical recurrence: current evidence and clinical applications

Emmanouil Panagiotidis¹, Filippos Koinis², George Angelidis^1,*, Varvara Valotassiou¹, Ioannis Tsougos³, Athanasios Kotsakis², Panagiotis Georgoulias¹
1 Nuclear Medicine Laboratory, University Hospital of Larissa, Larissa, Greece
2 Department of Oncology, University Hospital of Larissa, Larissa, Greece
3 Medical Physics Laboratory, University Hospital of Larissa, Larissa, Greece
* Corresponding Author: George Angelidis. Email: email
(This article belongs to the Special Issue: Advanced Multimodal Imaging for Localized Prostate Cancer and Biochemical Recurrence of Prostate Cancer)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.081194

Received 25 February 2026; Accepted 22 June 2026; Published online 29 July 2026

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Abstract

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has emerged as a transformative imaging modality in the management of prostate cancer, particularly for patients with localized disease and those experiencing biochemical recurrence (BCR). This review focuses on the clinical applications of PSMA PET imaging in these two critical clinical scenarios, where accurate disease detection and localization directly impact treatment decisions. For patients with localized high-risk prostate cancer, PSMA PET provides superior staging accuracy compared to conventional imaging, detecting occult lymph node and distant metastases that may change the therapeutic approach from curative local treatment to systemic therapy. In the setting of BCR, PSMA PET demonstrates remarkable detection capabilities even at very low prostate-specific antigen (PSA) levels, enabling accurate localization of recurrent disease sites in patients with established BCR, and guiding appropriate salvage treatment strategies. The integration of PSMA PET findings with clinical and pathological parameters enhances risk stratification and supports personalized treatment planning. This review examines the biological basis of PSMA expression, the development and characteristics of key PSMA radiotracers, the diagnostic performance in initial staging and BCR detection, and the clinical impact on management decisions. Additionally, the role of quantitative imaging biomarkers, standardized reporting systems, and potential limitations of PSMA PET are discussed. The available evidence demonstrates that PSMA PET imaging has become an indispensable tool in the modern management of localized prostate cancer and BCR, with significant implications for treatment selection and patient outcomes.

Keywords

prostate cancer; prostate-specific membrane antigen; positron emission tomography; localized disease; biochemical recurrence; staging; salvage therapy

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PSMA PET imaging in localized prostate cancer and biochemical recurrence: current evidence and clinical applications

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