[Procedure Guideline for Prostate Cancer Imaging with PSMA-ligand PET/CT].

Area of Science:

• Oncology
• Nuclear Medicine
• Radiochemistry

Context:

• Prostate-specific membrane antigen (PSMA)-PET/CT has become a global standard for prostate cancer (PC) imaging since 2011.
• While most experience is with recurrent PC, data for high-risk primary staging are promising.
• Numerous PSMA ligands are available, but only 68Ga-PSMA-11 and 18F-DCFPyL have FDA approval.

Purpose:

• To review the current status and clinical applications of PSMA-PET/CT in prostate cancer management.
• To discuss the available PSMA ligands, their approvals, and recommended imaging protocols.
• To highlight factors influencing image interpretation, including timing, patient preparation, and potential pitfalls.

Summary:

• PSMA-PET/CT is effective for recurrent and high-risk primary prostate cancer staging.
• Optimal imaging involves considering acquisition times, with late imaging potentially improving contrast.
• Patient preparation, including hydration and avoiding androgen deprivation therapy before imaging, is crucial for optimal lesion detection.

Impact:

• PSMA-PET/CT improves the accuracy of prostate cancer detection and staging.
• Understanding ligand properties and imaging protocols enhances diagnostic yield.
• Awareness of physiological uptake and potential pitfalls improves the interpretation of PSMA-PET/CT scans.