Over the past decade, prostate-specific membrane antigen positron emission tomography (PSMA-PET) has revolutionized prostate cancer (PCa) imaging, offering greater sensitivity and specificity compared to conventional imaging modalities such as CT, MRI, and bone scintigraphy. PSMA-PET is particularly valuable in staging newly diagnosed patients with intermediate- and high-risk disease, detecting biochemical recurrence, and evaluating metastatic cases. By utilizing radiotracers that accumulate specifically in PSMA-expressing cells, even small metastases can be detected, offering a detailed assessment of cancer extent and enabling more targeted diagnostic evaluations. Among the most utilized radiotracers, [68Ga]- and [18F]-labeled PSMA tracers enable precise imaging even with low disease burden. This diagnostic precision also supports advanced therapeutic approaches, including metastasis-directed therapy for oligometastatic cases and systemic treatment options, such as radioligand therapy, which presents new treatment perspectives for metastatic, castration-resistant PCa. This review examines the evolution of PSMA-PET in the diagnostics and therapy of PCa while comparing the current recommendations from leading clinical guidelines. The integration of PSMA-PET into clinical practice has redefined the management of PCa, improving diagnostic accuracy and enabling personalized treatment strategies, while lacking prospective long-term outcome data. As PSMA-PET continues to expand in clinical application, this review highlights its significant advancements while critically addressing limitations to ensure balanced and evidence-based implementation in prostate cancer care.
过去十年间，前列腺特异性膜抗原正电子发射断层扫描（PSMA-PET）以前所未有的方式革新了前列腺癌影像学领域，相较于CT、磁共振成像和骨扫描等传统影像技术，展现出更高的敏感性与特异性。该技术在初诊中高危患者的疾病分期、生化复发检测及转移病例评估方面具有突出价值。通过使用特异性聚集于PSMA表达细胞的放射性示踪剂，即使微小转移灶也能被精准识别，从而实现对癌症范围的精细评估，为靶向诊断提供可能。在临床最常用的示踪剂中，[68Ga]与[18F]标记的PSMA示踪剂即使在低肿瘤负荷条件下仍能实现精确成像。这种诊断精度同时为先进治疗策略提供支撑，包括针对寡转移病例的转移灶定向治疗，以及放射性配体疗法等系统治疗方案，为转移性去势抵抗性前列腺癌开辟了新的治疗前景。本文系统回顾PSMA-PET在前列腺癌诊疗领域的发展历程，并对比主流临床指南的现行推荐标准。PSMA-PET与临床实践的深度融合重塑了前列腺癌诊疗体系，在提升诊断准确性与推动个体化治疗策略的同时，仍需前瞻性长期预后数据的支持。随着PSMA-PET临床应用的持续拓展，本文在重点阐述其重大进展的同时，亦审慎探讨其局限性，以确保该技术在前列腺癌诊疗中实现基于循证医学的平衡发展。
Current Clinical Applications of PSMA-PET for Prostate Cancer Diagnosis, Staging, and Treatment
肿瘤(癌症)患者之家