Joint survey by AIMN, AIOM, AIRO, SIU, SIUrO, and Meet-URO about the use of PSMA PET imaging in prostate cancer in Italy: PSA persistence, biochemical recurrence, hormone-sensitive and castration-resistant metastatic settings

Abstract Background Prostate-specific membrane antigen (PSMA) PET/CT has transformed prostate cancer (PCa) management by improving lesion detection and guiding treatment decisions across disease stages. Following the first paper of the Italian PSMA Survey focused on technical aspects and primary staging, this second analysis explores its clinical use in PSA persistence after radical prostatectomy, biochemical recurrence (BCR), hormone-sensitive metastatic (mHSPC), and castration-resistant metastatic (mCRPC) settings. Methods A national cross-sectional survey was conducted jointly by five Italian scientific societies involving nuclear medicine physicians, medical oncologists, radiation oncologists, and urologists (AIMN, AIOM, AIRO, SIU, SIUrO) and the Meet-URO cooperative group. Dedicated sections addressed the adoption, timing, and perceived clinical impact of PSMA PET/CT in PSA persistence after radical prostatectomy, BCR, mHSPC, and mCRPC. Responses were analysed descriptively and stratified by medical competences (clinicians versus nuclear medicine physicians). Results PSMA PET/CT emerged as the preferred imaging modality in all clinical scenarios. In PSA persistence and BCR, 87–95% of respondents selected PSMA PET as first-line imaging, most often performed at PSA levels of 0.2–0.5 ng/mL. When negative, more than two-thirds recommended repeating PSMA PET/CT after PSA further rise. In mHSPC, over 80% of clinicians applied the CHAARTED criteria directly to PSMA PET findings, while PSMA PET/CT was also widely used for restaging and therapy monitoring. In mCRPC, PSMA PET/CT was routinely used for baseline and follow-up imaging. Most clinicians considered the low-dose CT component sufficient for radioligand therapy (RLT) eligibility, while [ 18 F]Fluorodeoxyglucose (FDG) PET was reserved for selected high-risk or discordant cases. Conclusion PSMA PET/CT has become the central imaging modality in the management of advanced PCa in Italy. Its adoption has progressed faster than supporting evidence, underscoring the need for prospective validation, implementation of harmonised interpretation criteria, and unified national recommendations.

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Publication Details

Journal
Clinical and Translational Imaging
Published
2026-04-14
DOI
https://doi.org/10.1007/s40336-026-00766-8
Primary Topic
Prostate Cancer Treatment and Research
Type
article
Field-Weighted Citation Impact
0.00

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article

Joint survey by AIMN, AIOM, AIRO, SIU, SIUrO, and Meet-URO about the use of PSMA PET imaging in prostate cancer in Italy: PSA persistence, biochemical recurrence, hormone-sensitive and castration-resistant metastatic settings

Filippo Antonica, Emanuela Cagna, Gabriella Arena, Luca Burroni et al.
Clinical and Translational Imaging
Prostate Cancer Treatment and Research
article

Joint survey by AIMN, AIOM, AIRO, SIU, SIUrO, and Meet-URO about the use of PSMA PET imaging in prostate cancer in Italy: PSA persistence, biochemical recurrence, hormone-sensitive and castration-resistant metastatic settings

Filippo Antonica, Emanuela Cagna, Gabriella Arena, Luca Burroni, Linda Cerbone, Filippo Alongi, Giuseppe Chiacchio, Sebastiano Buti, Lorenza Bruschieri, Cinzia Baiocco, Alfonso Baldoncini, Angelina Cistaro, Simona Borghesi, Pierpaolo Alongi, Paolo Carlini, Roberto Bortolus, Eugenio Borsatti, Domenico Cante, Simona Allis, Alberto Buffoli, Marco Maccauro, Giovanni Busacca, Natale Daniele Calandruccio, Isa Bossi Zanetti, Tommaso Carfagno, Maria Luisa De Rimini, Alberto Lapini, Demetrio Aricò, Greta Celesti, S. Cauda, ROLANDO MARIA D’ANGELILLO, Alessandra Cocchi, Stefano Ciccarelli, Valentina Baldazzi, Emanuele Casciani, Michelangelo Bambaci, Davide Campobasso, Alessio Bruni, Alessandra Castelluccia, Francesco Chierigo, Francesca Ambrosini, Antonino Battaglia, Paola Caroli, Michele Boero, Angelo Castello, Sergio Bracarda, Calogero Casà, Paolo Andrea Zucali, Claudia Caserta, Francesco Atzori, Umberto BASSO, Glauco Bertello, Amedeo Bonfiglio, Valentina Ceriani, Carmelo Caldarella, Domenico Barzaghi, Annalisa Bramati, Alessia Cavo, Giada Pinterpe, Monica Boitano, Michele Caruso, Francesco Ceci, G Brusasco, Valentina Borzillo, Rita Cengarle, Laura Evangelista, Angelina Filice, Lucia Barsacchi, Tommaso Brancato, Luca Antonelli, Cosimo Ciotta, Gabriele Bignante, Salvatore Carrozza, Giuseppe Candita, Nicolò Borsellino, Michele Bruno, Luca Sofia, Oriana Calisto, Angelo Andrea Chirillo, Gian Franco Bardino, Lucio Carozzi, Carlo Messina, M Bauckneht, Lilia Bardoscia, Riccardo Schiavina, Andrea Bianchi, Marco Krengli, Paolo Borghetti, Marco Maruzzo, Orazio Caffo, Domenico Albano, Giuseppe Fornarini, Giuseppe Carrieri, Marco Badalamenti, The PSMA PET Italian Survey Collaborators, Andrea Mari, Edoardo Cisero, Andrea Alberti, Raffaela Abate, Fabio Calabrò
article en

Abstract

Abstract Background Prostate-specific membrane antigen (PSMA) PET/CT has transformed prostate cancer (PCa) management by improving lesion detection and guiding treatment decisions across disease stages. Following the first paper of the Italian PSMA Survey focused on technical aspects and primary staging, this second analysis explores its clinical use in PSA persistence after radical prostatectomy, biochemical recurrence (BCR), hormone-sensitive metastatic (mHSPC), and castration-resistant metastatic (mCRPC) settings. Methods A national cross-sectional survey was conducted jointly by five Italian scientific societies involving nuclear medicine physicians, medical oncologists, radiation oncologists, and urologists (AIMN, AIOM, AIRO, SIU, SIUrO) and the Meet-URO cooperative group. Dedicated sections addressed the adoption, timing, and perceived clinical impact of PSMA PET/CT in PSA persistence after radical prostatectomy, BCR, mHSPC, and mCRPC. Responses were analysed descriptively and stratified by medical competences (clinicians versus nuclear medicine physicians). Results PSMA PET/CT emerged as the preferred imaging modality in all clinical scenarios. In PSA persistence and BCR, 87–95% of respondents selected PSMA PET as first-line imaging, most often performed at PSA levels of 0.2–0.5 ng/mL. When negative, more than two-thirds recommended repeating PSMA PET/CT after PSA further rise. In mHSPC, over 80% of clinicians applied the CHAARTED criteria directly to PSMA PET findings, while PSMA PET/CT was also widely used for restaging and therapy monitoring. In mCRPC, PSMA PET/CT was routinely used for baseline and follow-up imaging. Most clinicians considered the low-dose CT component sufficient for radioligand therapy (RLT) eligibility, while [ 18 F]Fluorodeoxyglucose (FDG) PET was reserved for selected high-risk or discordant cases. Conclusion PSMA PET/CT has become the central imaging modality in the management of advanced PCa in Italy. Its adoption has progressed faster than supporting evidence, underscoring the need for prospective validation, implementation of harmonised interpretation criteria, and unified national recommendations.

Clinical and Translational Imaging
University of Rome Tor Vergata (IT), Marche Polytechnic University (IT), Humanitas University (IT), University of Padua (IT), Ospedale Santa Chiara (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Ospedale Sacro Cuore Don Calabria (IT), Istituto Oncologico Veneto (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Azienda USL di Bologna (IT), Metropolitana Milanese (Italy) (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Usl Toscana Centro (IT), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), IRCCS Humanitas Research Hospital (IT), University of Florence (IT), University of Genoa (IT)
Associazione Italiana di Oncologia Medica, Università degli Studi di Genova
Good health and well-being
Openalex Percentile: Top 25%
Prostate Cancer Treatment and Research
DOIOpen Access PDFOpenAlex
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