The Use of PSMA PET/CT Scan in Patients with Prostate Cancer Treated with Focal Therapy

How to cite: Lughezzani G. The Use of PSMA PET/CT Scan in Patients with Prostate Cancer Treated with Focal Therapy. Grand Rounds in Urology. September 15, 2025. Accessed Mar 2026. https://grandroundsinurology.com/the-use-of-psma-pet-ct-scan-in-patients-with-prostate-cancer-treated-with-focal-therapy/

Summary

Giovanni Lughezzani, MD, Associate Professor of Urology, IRCCS Humanitas Research Hospital, Milan, Italy, evaluates the role of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) scans in guiding and monitoring focal therapy for prostate cancer. He shares insights into how PSMA PET/CT may complement multiparametric magnetic resonance imaging (MRI) in patient selection, treatment planning, and post-treatment follow-up.

Dr. Lughezzani highlights that PSMA is strongly expressed in prostate cancer cells and associated with tumor aggressiveness, making it a valuable biomarker for visualization and disease quantification. He emphasizes that PSMA PET has high specificity in staging, detecting biochemical recurrence, and supporting PSMA-targeted therapies, and may extend its utility to focal therapy pathways.

He reviews evidence from early studies demonstrating that PSMA PET correlates well with tumor volume compared to histology and may outperform multiparametric magnetic resonance imaging (MRI), which can underestimate disease in some patients. He notes that pilot studies suggest that PSMA PET can identify intra-prostatic recurrence after focal therapy even when MRI findings are negative or equivocal.

Dr. Lughezzani presents the development of the PSMA-FAB system, modeled after established MRI frameworks, to standardize response evaluation. This system classifies findings into categories reflecting complete response, indeterminate status, or treatment failure, thereby supporting decision-making on confirmatory biopsies and treatment adaptation. He further notes preliminary proposals for combining PSMA PET with multiparametric MRI into a Focal Therapy Imaging Response Evaluation Score, designed to improve reproducibility and guide clinical management.

Dr. Lughezzani asserts that while preliminary results are promising, external multicenter validation is required before routine adoption. PSMA PET may become a complementary imaging modality alongside multiparametric MRI for focal therapy patient selection and post-treatment assessment.

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.