Despite the developments of the last few years, metastatic castration-resistant prostate cancer (PC) remains a deadly disease. Until recently, almost all guidelines recommended magnetic resonance imaging (MRI) or computed tomography (CT) for the initial staging and local/systematic recurrence. Positron emission tomography/computed tomography (PET/CT) with prostate-specific membrane antigen (PSMA) at the present stage, emerged as a promising diagnostic imaging tool for PC. PSMA PET/CT alone or in combination with multiparametric magnetic resonance imaging (mpMRI) can improve the detection of clinically significant PC, especially for Prostate Imaging Reporting & Data System (PI-RADS) = 3 lesions. In addition, PSMA PET/CT is more accurate than CT and bone scan for intermediate to high-risk disease at the initial staging. Contrariwise, a negative PET is not useful for surgeons to avoid a pelvic nodal dissection. PET-PSMA imaging is appropriate for prostate-specific antigen (PSA) persistence or PSA rise from undetectable level after radical prostatectomy or for PSA rise above nadir after definitive radiotherapy. Also, it is recommended for patients fit for curative salvage treatment. It should be noted that in patients, candidates for radionuclide therapy with Lutetium-177 (117Lu), a PSMA strong expression from PET/CT at baseline is considered necessary. This review summarizes the evolution of PSMA PET/CT and its current role in the management of PC.

中文翻译：

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PSMA-PET 成像在前列腺癌临床治疗中的当前作用。

尽管过去几年取得了进展，转移性去势抵抗性前列腺癌（PC）仍然是一种致命的疾病。直到最近，几乎所有指南都推荐磁共振成像（MRI）或计算机断层扫描（CT）用于初始分期和局部/系统复发。现阶段，具有前列腺特异性膜抗原（PSMA）的正电子发射断层扫描/计算机断层扫描（PET/CT）已成为一种有前景的 PC 诊断成像工具。单独使用 PSMA PET/CT 或与多参数磁共振成像 (mpMRI) 结合使用可以改善临床上有意义的 PC 的检测，尤其是前列腺成像报告和数据系统 (PI-RADS) = 3 个病变。此外，对于中高危疾病的初始分期，PSMA PET/CT 比 CT 和骨扫描更准确。相反，PET 阴性对于外科医生来说并不能避免骨盆淋巴结清扫。PET-PSMA 成像适用于前列腺特异性抗原 (PSA) 持续存在或根治性前列腺切除术后 PSA 从不可检测的水平上升或根治性放疗后 PSA 上升至最低点以上。此外，建议适合进行挽救性治疗的患者。应该指出的是，在接受镥 177 (117Lu) 放射性核素治疗的患者中，基线时 PET/CT 的 PSMA 强表达被认为是必要的。本综述总结了 PSMA PET/CT 的演变及其当前在 PC 管理中的作用。