Bridging the PSMA PET/CT access gap in prostate cancer: evidence, barriers, and priorities for implementation

To examine the gap between evidence-based indications for PSMA PET/CT and real-world access in prostate cancer, with a focus on European implementation and country-specific experience from Spain and France. A focused narrative appraisal of published evidence, clinical guidelines, regulatory and reimbursement information, and real-world accessibility data was performed. European accessibility modelling and physician market research from Spain were incorporated to characterise implementation patterns and barriers. Access to PSMA PET/CT remains heterogeneous despite its established role in higher-risk staging and biochemical recurrence. Reported barriers include reimbursement and local approval requirements, PET/CT and nuclear medicine capacity, radiopharmaceutical logistics, non-standardised referral pathways, waiting times, and institutional variation. Exploratory modelling suggested that use remains below the estimated eligible population in both staging and biochemical recurrence, with differences between countries and clinical scenarios. Spanish market research similarly indicated substantial variation. These data are exploratory implementation signals rather than population-level epidemiological estimates. Improving access requires guideline-based eligibility criteria, harmonised reimbursement, regional referral networks, adequate imaging and reporting capacity, reliable tracer supply, and measurable access indicators. Further research should determine whether reducing implementation gaps improves diagnostic pathways and treatment allocation.