How to cite: Gamie SH. PSMA PET/CT in prostate cancer imaging. Grand Rounds in Urology. November 2025. Accessed February 2026. https://grandroundsinurology.com/psma-pet-ct-in-prostate-cancer-imaging/
Summary
Sherief H. Gamie, MD, PhD, Chief & Director, Molecular Imaging and Theranostics, Professor of Clinical Radiology, University of California San Diego Health, San Diego, California, focuses on how prostate-specific membrane antigen positron emission tomography (PSMA PET)/computed tomography (CT) is changing prostate cancer imaging, staging, recurrence detection, and treatment guidance, and how it compares with conventional imaging approaches.
Dr. Gamie reviews the evolution of PET imaging, explaining how PSMA PET provides prostate cancer-specific molecular targeting. He describes the currently used PSMA tracers, noting their radiolabel differences, excretion characteristics, and dual diagnostic-therapeutic capabilities. A key emphasis is the expanding role of PSMA PET beyond biochemical recurrence into primary staging, where it demonstrates high detection capability and improved sensitivity for lesions across local, nodal, bone, and distant sites.
He explains that PSMA PET identifies disease earlier at lower prostate-specific antigen (PSA) levels than conventional modalities and offers single-study whole-body decision support. In the presentation, Dr. Gamie discusses how PSMA PET findings influence management decisions, including determining oligometastatic versus polymetastatic disease, guiding localized treatments, and supporting systemic escalation. He repeatedly emphasizes the importance of selecting the appropriate PSMA agent, given differences in urinary clearance and lesion visibility.
Dr. Gamie discusses biochemical recurrence, noting detection capability at low PSA levels and meaningful positivity even with slow PSA doubling. He highlights how PSMA PET can identify lesions not seen on magnetic resonance imaging (MRI) and describes the growing interest in PET/MR combinations, suggesting they may enhance localization and recurrence detection.
Shifting to theranostics, Dr. Gamie reviews how PSMA imaging supports selection for radioligand therapy, including lutetium-177–based treatment, and explains that therapy choice aligns with tracer uptake characteristics. He describes outcome guidance, tolerability considerations, and expanding global development in theranostic agents.
Dr. Gamie emphasizes that PSMA PET has created a major shift across prostate cancer diagnosis, staging, recurrence evaluation, and therapeutic targeting, supporting precision oncology approaches and improved decision-making.
About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Sherief H. Gamie, MD, PhD, is the Chief and Director of the Nuclear/Molecular Imaging and Theranostics Program and Professor of Radiology at the University of California, San Diego, San Diego, California. Dr. Gamie specializes in nuclear medicine, with expertise in molecular imaging and theranostics, applying precision-targeted radiopharmaceuticals in the diagnosis and treatment of numerous malignancies.
