Prostate-Specific Membrane Antigen (PSMA) PET: A Counterpart to Prostate MRI

Abstract

Abstract Prostate cancer is projected to remain the second leading cause of cancer-related death in men in the United States in 2021[1]. Traditionally, initial staging and post-treatment surveillance require a variety of imaging exams, from bone scan and CT to MRI, however conventional imaging is limited by low sensitivity[2-4]. This has given rise to the development of radiotracers which target molecular processes more specific for prostate cancer, such as 11 C- or 18 F-choline and 18 F-fluciclovine [4] . In December 2020, 68 Ga-prostate-specific membrane antigen-11 (68 Ga-PSMA-11) received FDA approval for use in men with prostate cancer in the United States[5]. Studies have consistently demonstrated superior performance of 68 Ga-PSMA-11, 11 C-/ 18 F-choline and 18 F-fluciclovine PET for cancer detection compared to conventional imaging, particularly at PSA levels of less than 1.0 ng/mL[3, 6-10]. A recent study showed that 68 Ga-PSMA-11 PET led to significantly more frequent changes in patient management than conventional imaging[9]. The increasing availability of PSMA PET/MR scanners is likely to pave the way for simultaneous integration of anatomic, functional and biologic information for men undergoing prostate cancer care[4]. In this article, we provide an overview of the clinical applications of 68 Ga-PSMA-11 PET-MR with case examples.