What is PSMA PET?

A prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan is an advanced imaging method that allows you to see where your prostate cancer is located in your body and if it has spread.1

Learning about how PSMA PET is used can help you make informed decisions about your care under the guidance of your healthcare provider.

BIGGEST DIAGNOSTIC ADVANCE IN DECADES
“Without a doubt PSMA PET scanning has become the biggest advance in prostate cancer diagnostics.”
Michael David Lutz, MD, Partner at the Michigan Institute of Urology, President of the MIU Men’s Health Foundation
Watch video View transcript
Dr Michael David Lutz

Video transcript

Michael David Lutz, MD, Partner at the Michigan Institute of Urology, President of the MIU Men’s Health Foundation

What are some of the challenges when treating prostate cancer?

Michael David Lutz, MD

Partner at the Michigan Institute of Urology

President of the MIU Men’s Health Foundation

One of the biggest challenges in following a patient with prostate cancer is the suspected biochemical recurrence with an elevated PSA. And PSMA PET CT scanning has without a doubt been the biggest game changer because we can now pick up disease which we once called oligometastatic disease that disease that we couldn't actually see by classic or standard imaging.

Dr Michael David Lutz
FINDING RECURRENT PROSTATE CANCER
“It identified immediately where the cancer had recurred… it gave everybody an idea of how extensive the cancer was.”
Michael Crosby, CEO & President of Veterans Prostate Cancer Awareness, Prostate Cancer Survivor
Watch video View transcript
Michael Crosby

Video transcript

Michael Crosby, CEO & President of Veterans Prostate Cancer Awareness, Prostate Cancer Survivor

What has been your experience of imaging in prostate cancer? 

Michael Crosby 

CEO & President of Veterans Prostate Cancer Awareness 

Prostate Cancer Survivor 

I've been through the evolution of all this imaging. And when you start, or when you, when I was first diagnosed, we had MRI and a bone scan, basically, which is debatable what the resolutions are, what machine you're on, you know, is it going to show metastasis; MRIs, as probably everybody has seen is just black and white; it's all up to interpretation and resolution. 

Compared to MRI and bone scans, how is PSMA PET imaging different? 

It identified immediately where the cancer had recurred. Not only did it give the doctors and the physicians an opportunity to know, or the vision of where this cancer is, it gave everybody an idea of how extensive the cancer was. 

How is PSMA PET imaging relevant for recurrent prostate cancer patients? 

When you have a recurrence, I think sometimes it's worse than the initial diagnosis. And so, you're looking, you're searching for answers. You're wondering ‘Why? Where's this coming from? What's happening to your, to yourself? And ‘Why can't you stop this?’ There's a lot of why's going on late at night. 

What impact do you think PSMA PET imaging can have on a patient’s well-being? 

It provides a patient with a sense of well-being, you kind of know; now, you know, regardless of whether you have metastasis all over, it's extensively metastasized, or you've got one [lesion], at least you know, what, what you're dealing with. 

How does seeing prostate cancer using PSMA PET imaging help? 

From a mental health perspective, from a, from a patient who's in the middle of this fight, to be able to see something and to be able to understand, just visually, we're kind of visual creatures. It’s why, you know, we look at things right, and we make assessments on what we see, at least the doctors can tell you that now they know where it's at, before precision imaging or this really precise imaging, it was a guess nobody knew. They would miss different metastasis on things like on your ribs or on your shoulders, or on your hips. 

How does PSMA PET imaging influence treatment options and decisions? 

Now, if you identify these small metastases everywhere, you can get into things like you know, oligometastatic radiation treatments, and other kinds of treatments now that allow you to actually target those small metastases, and, and fight the cancer and take care of it. 
Michael Crosby
GIVING PATIENTS THE ‘ALL CLEAR’
“There's nothing better than telling a patient that it's all clear and we're going to go for cure.”
Tom Boike, MD, Radiation Oncologist, GenesisCare
Watch video View transcript
Dr Tom Boike

Video transcript

Tom Boike, MD, Radiation Oncologist, GenesisCare

How does PSMA PET imaging help with prostate cancer staging?

Tom Boike, MD

Radiation Oncologist, GenesisCare

When we look at initial staging for prostate cancer, PSMA PET has become an integral part of our pathway. For all patients with unfavorable intermediate risk or high risk, we get [PSMA PET]. And unfortunately, we've seen patients on conventional imaging where they had positive findings on bone scan that were nonspecific. But when they came to us, they were told they had metastatic disease. A crushing diagnosis; affecting their whole life, you know, needing treatment after treatment. And when we did a PSMA PET scan, these patients weren't found to have metastatic disease, their, you know, rib lesion was negative, or their spine lesion was negative. So, it really changes the management and the staging of these patients.
Dr Tom Boike
CHANGING PROSTATE CANCER TREATMENT PARADIGMS
“It really can't be overstated how much our treatment paradigms have been changing since we've had PSMA PET imaging.”
Ben Lowentritt, MD, Medical Director of the Prostate Cancer Program at Chesapeake Urology
Watch video View transcript
Dr Ben Lowentritt

Video transcript

Ben Lowentritt, MD, Medical Director of the Prostate Cancer Program at Chesapeake Urology

What are the advantages of PSMA PET imaging over conventional imaging?

Ben Lowentritt, MD

Medical Director of the Prostate Cancer Program at Chesapeake Urology

So, there are many advantages to PSMA PET imaging, I think, though the two biggest ones are the ability to see smaller lesions, both in the bone and in lymph nodes, especially normal sized lymph nodes. And then in addition, there's the ability to be more confident that what we're seeing is prostate cancer, the specificity of what we're getting, and what the results are.

Dr Ben Lowentritt

Beyond The Scan: Navigating the Pitfalls of False Results in PSMA-PET Imaging 

PSMA-PET scans are vital tools in prostate cancer detection and treatment planning, offering high accuracy in pinpointing cancerous areas in high-risk cases relative to conventional imaging techniques.2,3,4 However, despite their effectiveness, there's a small chance of encountering false positives and false negative results during the imaging process.5,6

False results can arise due to various factors such as inflammation or benign prostatic conditions, which can mimic cancerous activity.7 Similarly, false negatives may occur when the cancer is small or located in challenging areas that are not adequately captured by the scan.7

Good to know:

It's important to know that these risks are common for all advanced imaging techniques used for prostate cancer.7,8 Doctors are aware of this and will carefully review your results to make sure they're making the best decisions for your care.

PSMA and PSA - what's the difference?

You may already be familiar with prostate-specific antigen (PSA), as it’s detection via a simple blood test is widely used to help diagnose and to monitor prostate cancer.9 But what is PSMA, and how does it differ from PSA?

Prostate-specific membrane antigen
Cancer cell graphic
  • A protein that sits on the surface of more than 90% of prostate cancer cells10
  • PSMA is detected by imaging1

PSMA is a protein that sits on the surface of almost all prostate cancer cells, and is an accurate way to detect where the cancer is located in your body.1,10

Prostate-specific antigen
PSA test
  • A protein produced by normal and prostate cancer cells9
  • PSA is detected in blood and semen9

PSA is a protein that is normally produced by prostate cells. It can be detected in both the semen and in the blood.9 When there is a problem with the prostate, such as prostate cancer, PSA levels can increase.9

About PSA testing

A PSA test is one of the important steps in the initial diagnosis of prostate cancer.9

Follow-up PSA tests are used to monitor the effects of treatments and to check if the cancer has returned.9

There is no specific number that signals prostate cancer but generally:9

  • A PSA below 4 (ng/mL) is considered to be within the normal range
  • A PSA above 10 (ng/mL) is a strong indicator there could be prostate cancer

Using imaging to detect PSMA

PSMA can be detected using a PET scan and a low-level radioactive tracer that specifically seeks out and attaches to PSMA.1 As PSMA is located on almost all prostate cancer cells this enables doctors to see exactly where your cancer is and how far it has spread throughout the body.1

PSMA PET, like X-rays, bone scans and computed tomography (CT), uses radiation. The amount of radiation that you are exposed to is temporary and not much higher than the level of radiation that you are exposed to in everyday life.11

YOU CAN SEE WHAT YOU'RE UP AGAINST
"PSMA PET gives you a picture of what you’re really up against. That mental vision of what you’re trying to combat gives you a sense of encouragement, and emboldens you to go against it."
MICHAEL CROSBY
Watch video View transcript
Michael Crosby

Video transcript

MICHAEL CROSBY

LIVING WITH PROSTATE CANCER 

What does the scan show you?

It is obvious when you see it [prostate cancer], it shows up, most of the [PSMA PET] scan is sort of black and grey. But when you see some prostate cancer, it's bright yellow, and red. And so, it's very easy to see. And that's uh, what's happened with that is it's almost an encouraging mental picture. Because for years and years, all you would have as a prostate cancer patient is a number on a piece of paper, maybe you would get to see the MRI or CT scans, and they would try to tell you that, you know, this black dot is a little bit more dense than this dot and then, but it really was kind of meaningless. The real change now is that you can actually visualize where your cancer is and how extensive it is. And it gives you a picture of what you're really up against.  
Michael Crosby

Watch Michael’s story

How are PSMA PET scans performed?

Performed 01
01.
To perform a PSMA PET scan, you will receive an injection of a small amount of a low-level radioactive tracer.
Performed 02
02.
After a short wait, you’ll then be asked to lie on the padded scanner bed and raise your arms above your head. The scanner bed then moves slowly across you; it typically starts at your mid-thigh then goes up towards your head.
Performed 03
03.
The scan will be done approximately 1 hour after the injection, take approximately 40 minutes or less, and the results will be sent to your doctor.
Performed 04 graphic
04.
After the scan you will need to keep yourself hydrated by drinking lots of water and go to the bathroom as much as needed in the first few hours. This is to help ensure that all of the radioactive tracer has left your body.

Why PSMA PET?

There are several advantages to using PSMA PET for detecting prostate cancer.

  • It is accurate – PSMA PET finds prostate cancer wherever it is in the body.1,10
  • Detects tiny areas of prostate cancer – PSMA PET can find prostate cancer that other imaging methods often cannot.12
  • Detects at low PSA levels – PSMA PET finds prostate cancer even when PSA levels are low.13
  • Helps plan the best treatment – PSMA PET enables doctors to see how far your cancer has spread and help you both decide on the best treatment plan.1

What can PSMA PET Scans show you?

Representation of what you can see using a PSMA PET scan versus a bone scan.14

PSMA PET Scan
PSMA PET Scan graphic

Prostate cancer can be seen throughout the body

Bone Scan
Bone Scan graphic

Prostate cancer can only be seen in the bones

Source: Tsechelidis I, Vrachimis A. Front Oncol. 2022 28;12:831429.

Daniel Carter
PSMA PET aids treatment decisions
Daniel Canter
MD, Georgia Urology
“PSMA/PET scans provide more information to add to decision-making for potentially better outcomes. Patients should ask their providers about these resources.

The good news is that prostate cancer is treatable and oftentimes curable. Even for men with metastatic disease, it is treatable for a long period of time.”

Other types of scans used for prostate cancer detection

There are several other types of scans used to diagnose and stage prostate cancer which are described briefly here.

Bone scan
  • Checks if prostate cancer has spread into your bones.9,15
  • A radioactive imaging agent is injected into your arm and after a 2-3-hour wait to allow this to be absorbed by your body you will go for the scan.15 You then lie on a padded table that moves back and forth within a scanning machine for about an hour.15  The scan will show areas of bone where the imaging agent has collected and thus if prostate cancer is present.15
  • Performed in a radiology or nuclear medicine department of a hospital; it is a type of nuclear medicine scan and may also be referred to as bone scintigraphy.15
  • Keep hydrated after the scan and go to the bathroom as often as you need. This will help to remove the radioactive imaging agent from your body.
MRI scan
  • MRI uses strong magnets to make images of inside the body that appear in cross sections.9
  • It is important to tell your doctor and inform the person performing the scan if you have any medical devices implanted in your body.9,16,17 This includes pacemakers (defibrillators), stents, hip and knee replacements, hearing implants, and drug pumps.16,17 Also tell them if you have any tattoos or wear drug patches. The reason is that the latter may cause skin irritation, and the medical devices may contain metal that could heat up during the scan and can cause burns if you are not properly protected.17
  • An MRI scanner consists of a long tube and for the scan you will need to lie on a padded table which will slide into the scanner.9
  • You may need to be inside the scanner for 45 to 60 minutes which can make some people feel claustrophobic or anxious.9
  • Talk to one of your healthcare team about any concerns you have as they may be able to suggest ways to reduce your anxiety during the scan.
  • MRI scans can be noisy. You should be offered hearing protection, and you may be able to wear headphones and listen to music.15,16
CT Scan
  • CT scans use X-rays to create images of the inside of the body which are seen as cross-sections.9
  • Like a bone scan you will need to lie on a padded table that moves back and forth through the scanner for up to half an hour.9 
  • A contrast imaging agent may be used; this is either injected into your arm or you may be asked to drink a liquid that contains it.9 
  • While commonly used, CT scans are not as useful as MRI or other scans for looking at the prostate gland itself.9

Trusted Prostate Cancer Resources

Where to find further information on prostate cancer that you can trust

Read more

Start the discussion

Download questions to ask your doctor

Sign up for updates

We’ll be updating this website with new information on a regular basis so we hope you will check back with us again soon.

By providing your email here you are consenting to receiving information from us. You can unsubscribe at any time. Please refer to our Privacy Policy for further information.

References

  1. Kwon DH, et al. PSMA PET Scan. JAMA Oncol. 2022;8(12):1860.
  2. Morris MJ, Rowe SP, Gorin MA,et al. CONDOR Study Group. Clin CancerRes. 2021;27(13):3674-3682.
  3. Pienta KJ, Gorin MA, Rowe SP,et al. OSPREY Study Group. J Urol. 2021;206(1):52-61.
  4. Hoffman MS, Lawrentshuck L, Francis RJ,et al. Lancet. 2020;395(10231):1208-1216.
  5. Orevi M, Ben-Haim S, Abourbeh G,et al. Front Surg. 2022;9:943760.
  6. Schöder H, Hope TA, Knopp M,et al. J Clin Oncol. 2022;40(13):1500-1505.
  7. de Galiza Barbosa F, Queiroz MA, Nunes RF,et al. Cancer Imaging. 2020;20(1):23.
  8. Arafa MA, Rabah DM, Khan F,et al. Urol Ann. 2023;15(1):54-59.
  9. American Cancer Society. Prostate Cancer. Accessed July 1, 2023.
  10. Ceci F, et al. PSMA PET/CT imaging in prostate cancer: why and when. Clin Transl Imaging. 2019;7:377–379.
  11. American Cancer Society. How are people exposed to X-rays and gamma rays? Accessed July 1, 2023.
  12. Alipour R, Azad A, Hofman MS. Guiding management of therapy in prostate cancer: time to switch from conventional imaging to PSMA PET? Ther Adv Med Oncol. 2019; 11:1758835919876828.
  13. Morris MJ, Rowe SP, Gorin MA,et al. Diagnostic performance of (18)F-DCFPyL-PET/CT in men with biochemically Recurrent Prostate Cancer: Results from the CONDOR phase III, multicenter study. Clin Cancer Res. 2021;27(13):3674-82.
  14. Tsechelidis I, Vrachimis A. PSMA PET in imaging prostate cancer. Front Oncol. 2022 28;12:831429.
  15. American Cancer Society. Nuclear medicine scans for cancer. Accessed September 30, 2023.
  16. American Cancer Society. MRI for cancer. Accessed September 30, 2023.
  17. Food and Drug Administration. What patients should know before having an MRI exam. Accessed September 30, 2023.