How to cite: Ross AE. Future Indications of PET PSMA Imaging in Localized Prostate Cancer. Grand Rounds in Urology. September 15, 2025. Accessed Mar 2026. https://grandroundsinurology.com/future-indications-of-pet-psma-imaging-in-localized-prostate-cancer/
Future Indications of PET PSMA Imaging in Localized Prostate Cancer – Summary
Ashley E. Ross, MD, PhD, Associate Professor of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, discusses the evolving role of prostate-specific membrane antigen positron emission tomography (PSMA PET) in localized prostate cancer. He emphasizes how advanced imaging can refine risk assessment and influence treatment decisions.
Dr. Ross reviews data demonstrating that PSMA PET improves the detection of nodal and distant metastases compared with conventional imaging. This allows more accurate identification of patients with occult advanced disease who may not benefit from local therapy alone. He highlights that the use of PSMA PET is expanding to risk stratification at initial diagnosis and to evaluation before definitive treatment.
Emerging evidence suggests that PSMA PET may reclassify patients by revealing micrometastatic disease that is not visible on standard imaging. This has implications for clinical trial design, patient counseling, and appropriate use of surgery or radiotherapy. Ongoing trials are assessing whether tailoring management based on PSMA PET findings improves outcomes.
Dr. Ross also notes several limitations, including sensitivity at low prostate-specific antigen (PSA) levels, variability in interpretation, and uncertainty regarding the optimal incorporation of new findings into treatment algorithms. Prospective evidence is needed to confirm survival benefits and to standardize imaging thresholds.
Dr. Ross stresses that PSMA PET has changed the landscape of prostate cancer imaging. Future directions include integrating artificial intelligence and molecular classifiers to individualize the management of localized disease.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical case and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Ashley E. Ross, MD, PhD, is Executive Medical Director at Mary Crowley Cancer Research in Dallas, Texas. He also practices as a physician with Texas Oncology Practice Associates and Texas Urology Specialists. He was formerly an Associate Professor of Urology and Oncology at the Johns Hopkins School of Medicine where he led the Brady Urological Prostate Cancer Program and co-directed the Sidney Kimmel Cancer Center’s multidisciplinary prostate cancer clinic. Dr. Ross has been particularly interested in evaluating novel diagnostics and therapeutics and has led trials testing biomarkers for prostate cancer diagnosis, novel imaging modalities for staging, genomic markers to assess risk, and therapeutic trials for high-risk disease and low-volume metastatic disease. Dr. Ross is an Associate Editor of the “Journal of Prostate Cancer and Prostatic Diseases,” “Urology,” and “Annals of Surgical Oncology.” He is on the editorial board of the “British Journal of Urology” and “Urology Practice.” He has been recognized with numerous awards and honors, including the Johns Hopkins Clinical Scientist Award, the Department of Defense Prostate Cancer PTRA Award, the Patrick C. Walsh Prostate Cancer Research Award, and a Prostate Cancer Foundation Young Investigator Award.
