Prostate Anatomy: What Is Relevant for a Nuclear Medicine Practitioner

Area of Science:

• Nuclear medicine
• Radiology
• Oncology

Background:

• Prostate-specific membrane antigen (PSMA) PET imaging is increasingly vital for prostate cancer management.
• Accurate interpretation requires integrating anatomical, physiological, and molecular insights beyond standard imaging patterns.

Purpose of the Study:

• To provide a comprehensive review of prostate zonal anatomy, multimodality imaging, and the biology of PSMA expression.
• To elucidate variations in PSMA uptake, diagnostic pitfalls, and post-treatment imaging changes.
• To enhance diagnostic accuracy and optimize patient selection for PSMA-based theranostics.

Main Methods:

• Review of prostate zonal anatomy and multimodality imaging (ultrasound, multiparametric MRI, PSMA PET/CT).
• Analysis of the underlying biology of PSMA expression and androgen receptor signaling.
• Correlation of imaging findings with treatment effects (androgen-deprivation therapy, radiation, prostatectomy).

Main Results:

• Detailed description of prostate zonal anatomy and its relevance to PSMA uptake.
• Identification of physiologic and pathologic variations in PSMA expression.
• Characterization of imaging changes following various prostate cancer treatments.

Conclusions:

• Integrating anatomical, molecular, and physiological knowledge is key for accurate PSMA PET interpretation.
• Understanding treatment-induced changes improves diagnostic confidence.
• This review offers a practical foundation for nuclear medicine practitioners using PSMA-based imaging and therapy.