The Impact of PSMA PET/CT on Modern Prostate Cancer Management and Decision Making—The Urological Perspective

SIMPLE SUMMARY: Prostate cancer diagnosis and treatment options have rapidly improved over the last few years. A growing number of publications have moved to front the utilization of PSMA-based PET CT in clinical practice aimed to improve urologists’ ability to stage and grade prostate cancer. While this important imaging modality was initially utilized in advanced prostate cancer treatment, recent publications support its use even earlier in the course of the disease, prior to initial treatment selection and as part of the follow-up afterward. As clinical experience with the use of PSMA PET CT grows, it slowly moves into the front row and becomes more evident in PCa diagnostic protocols and treatment decision-making. This review aims to better understand the role of this important tool in current PCa management based on current published data. ABSTRACT: Prostate-specific membrane antigen (PSMA) PET use in prostate cancer treatment has recently become a routinely used imaging modality by urologists. New, established data regarding its performance in different stages of prostate cancer, as well as gaining clinical knowledge with new tracers, drives the need for urologists and other clinicians to improve the utilization of this tool. While the use of PSMA PET/CT is more common in metastatic disease, in which it outperforms classical imaging modalities and drives treatment decisions and adjustments, recently, it gained ground in localized prostate cancer as well, especially in high-risk disease. Still, PSMA PET/CT might reveal lesions within the prostate or possibly locoregional or metastatic disease, not always representing true cancer when utilized in earlier stages of the disease, potentially adding diagnostic burden and changing treatment decisions. As urological treatment options advance toward focal treatments in localized organ-confined prostate cancer, recent reports suggest the utilization of PSMA PET/CT in treatment planning and follow-up and even when choosing active surveillance. This review aims to reveal the current perspective of urologists regarding its daily use.