ESUR: Opportunities for PSMA-PET/CT and whole-body MRI in advanced prostate cancer

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computed tomography (CT), and whole-body magnetic resonance imaging (WB-MRI) are superior to conventional CT and bone scan imaging for detecting metastatic disease in patients with prostate cancer. While these higher-accuracy imaging methods have already shown the potential to enhance patient outcomes, a thorough understanding of the relationship between the treatment landscape and disease volume on conventional imaging, as well as the prognostic significance of the prostate-specific antigen response, is crucial for determining how they can be more effectively incorporated. Prospective clinical trials are required to evaluate whether PSMA-PET/CT and WB-MRI can genuinely improve clinically relevant endpoints for patients through precise treatment adaptations. In this paper, we explore the specific opportunities of PSMA-PET/CT and WB-MRI as biomarkers in multiple clinical domains, including metastasis detection and staging, disease characterisation and aggressiveness assessments, biopsy target selection, impacts on treatment planning, evaluation of therapeutic response, and theranostics. We highlight the central research questions that require attention. KEY POINTS: Question Can PSMA-PET/CT and WB-MRI, with their superior ability to detect metastases in prostate cancer, truly improve patient outcomes? Findings High-accuracy imaging improves metastasis detection, staging, assessment of disease aggressiveness, and enables more personalised treatment planning for advanced prostate cancer patients. Clinical relevance PSMA-PET/CT and WB-MRI have the potential to alter the management of men with advanced prostate cancer, but prospective clinical trials are needed to confirm benefits for survival or quality of life before recommending routine use.

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Publication Details

Journal
European Radiology
Published
2025-11-05
DOI
https://doi.org/10.1007/s00330-025-12089-9
Citations
3
Primary Topic
Prostate Cancer Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
4.56

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article

ESUR: Opportunities for PSMA-PET/CT and whole-body MRI in advanced prostate cancer

Tobias Penzkofer, Silke Gillessen, Samuel J. Withey, Raquel Pérez-López et al.
3 citations
European Radiology
Prostate Cancer Diagnosis and Treatment
4.56
article

ESUR: Opportunities for PSMA-PET/CT and whole-body MRI in advanced prostate cancer

Tobias Penzkofer, Silke Gillessen, Samuel J. Withey, Raquel Pérez-López, Ailin Dehghanpour, Jochen Walz, Sungmin Woo, Martina Pecoraro, Roberto García‐Figueiras, Frederic E. Lecouvet, Tara Barwick, Anwar R. Padhani, Luca Russo, Amish Lakhani, Wolfgang P. Fendler, Matthias Eiber, Ivo G. Schoots, Giuseppe Petralia, Chen‐Jiang Wu
article en
3 citations

Abstract

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computed tomography (CT), and whole-body magnetic resonance imaging (WB-MRI) are superior to conventional CT and bone scan imaging for detecting metastatic disease in patients with prostate cancer. While these higher-accuracy imaging methods have already shown the potential to enhance patient outcomes, a thorough understanding of the relationship between the treatment landscape and disease volume on conventional imaging, as well as the prognostic significance of the prostate-specific antigen response, is crucial for determining how they can be more effectively incorporated. Prospective clinical trials are required to evaluate whether PSMA-PET/CT and WB-MRI can genuinely improve clinically relevant endpoints for patients through precise treatment adaptations. In this paper, we explore the specific opportunities of PSMA-PET/CT and WB-MRI as biomarkers in multiple clinical domains, including metastasis detection and staging, disease characterisation and aggressiveness assessments, biopsy target selection, impacts on treatment planning, evaluation of therapeutic response, and theranostics. We highlight the central research questions that require attention. KEY POINTS: Question Can PSMA-PET/CT and WB-MRI, with their superior ability to detect metastases in prostate cancer, truly improve patient outcomes? Findings High-accuracy imaging improves metastasis detection, staging, assessment of disease aggressiveness, and enables more personalised treatment planning for advanced prostate cancer patients. Clinical relevance PSMA-PET/CT and WB-MRI have the potential to alter the management of men with advanced prostate cancer, but prospective clinical trials are needed to confirm benefits for survival or quality of life before recommending routine use.

European Radiology
Università Cattolica del Sacro Cuore (IT), Cliniques Universitaires Saint-Luc (BE), Royal Marsden NHS Foundation Trust (GB), University of Milan (IT), Erasmus MC (NL), Charing Cross Hospital (GB), Agostino Gemelli University Polyclinic (IT), TUM Klinikum (DE), The Netherlands Cancer Institute (NL), Ente Ospedaliero Cantonale (CH), Complejo Hospitalario Universitario de Santiago (ES), Advanced Radiation Therapy (United States) (US), Mount Vernon Cancer Centre (GB), Oncode Institute (NL), Essen University Hospital (DE), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Institut Paoli-Calmettes (FR), Jiangsu Province Hospital (CN), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Vall d'Hebron Institute of Oncology (ES), Università della Svizzera italiana (CH), European Institute of Oncology (IT), University of Duisburg-Essen (DE), Technical University of Munich (DE), Charité - Universitätsmedizin Berlin (DE), Nanjing Medical University (CN), Sapienza University of Rome (IT)
Amgen, AstraZeneca, Intuitive Surgical, Novocure, Clovis Oncology, Incyte, Advanced Accelerator Applications, Veracyte, European Commission, Deutsche Forschungsgemeinschaft, Bundesministerium für Bildung und Forschung, European Association of Urology, Astellas Pharma, Astellas Pharma Europe, Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung, Ipsen, Berlin Institute of Health, Takeda Oncology, Janssen Pharmaceuticals, Cilag
Openalex Percentile: Top 5%
Prostate Cancer Diagnosis and Treatment
4.56
DOIOpen Access PDFOpenAlex
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