Indikationen zur Durchführung der PSMA-PET-CT im Rahmen der Prostatakarzinomdiagnostik

Zusammenfassung

Die Positronenemissionstomografie/Computertomografie mit prostataspezifischem Membranantigen (PSMA-PET/CT) wird zunehmend in verschiedenen Indikationen eingesetzt. Ursprünglich auf die Diagnostik fortgeschrittener Tumorstadien beschränkt, findet sie heute auch Anwendung in der Primärdiagnostik und Risikostratifizierung über nahezu alle Stadien des Prostatakarzinoms hinweg.

Publication History

Article published online:
13 February 2026

• Literatur

• 1 Lopci E, Guazzoni G, Lazzeri M. et al. (68)Ga Prostate-specific Membrane Antigen PET/CT for Primary Diagnosis of Prostate Cancer: Complementary or Alternative to Multiparametric MR Imaging. Radiology 2018; 287: 725-726
• 2 Lopci E, Saita A, Lazzeri M. et al. (68)Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study. J Urol 2018; 200: 95-103
• 3 Emmett L, Buteau J, Papa N. et al. The Additive Diagnostic Value of Prostate-specific Membrane Antigen Positron Emission Tomography Computed Tomography to Multiparametric Magnetic Resonance Imaging Triage in the Diagnosis of Prostate Cancer (PRIMARY): A Prospective Multicentre Study. Eur Urol 2021; 80: 682-689
• 4 Meissner VH, Rauscher I, Schwamborn K. et al. Radical Prostatectomy Without Prior Biopsy Following Multiparametric Magnetic Resonance Imaging and Prostate-specific Membrane Antigen Positron Emission Tomography. Eur Urol 2022; 82: 156-160
• 5 Chaloupka M, Apfelbeck M, Pyrgidis N. et al. Radical Prostatectomy without Prior Biopsy in Patients with High Suspicion of Prostate Cancer Based on Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen Positron Emission Tomography: A Prospective Cohort Study. Cancers (Basel) 2023; 15: 1266
• 6 Krausewitz P, Bundschuh RA, Gaertner FC. et al. DEPROMP Trial: the additive value of PSMA-PET/CT-guided biopsy for prostate cancer management in biopsy naïve men-study protocol for a randomized trial. Trials 2023; 24: 167
• 7 Zettinig O, Shah A, Hennersperger C. et al. Multimodal image-guided prostate fusion biopsy based on automatic deformable registration. Int J Comput Assist Radiol Surg 2015; 10: 1997-2007
• 8 Simopoulos DN, Natarajan S, Jones TA. et al. Targeted Prostate Biopsy Using (68)Gallium PSMA-PET/CT for Image Guidance. Urol Case Rep 2017; 14: 11-14
• 9 Zhang L-L, Li W-C, Xu Z. et al. (68)Ga-PSMA PET/CT targeted biopsy for the diagnosis of clinically significant prostate cancer compared with transrectal ultrasound guided biopsy: a prospective randomized single-centre study. Eur J Nucl Med Mol Imaging 2021; 48: 483-492
• 10 Kawada T, Yanagisawa T, Rajwa P. et al. Diagnostic Performance of Prostate-specific Membrane Antigen Positron Emission Tomographytargeted biopsy for Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2022; 5: 390-400
• 11 Hofman MS, Lawrentschuk N, Francis RJ. et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 2020; 395: 1208-1216
• 12 Chow KM, So WZ, Lee HJ. et al. Head-to-head Comparison of the Diagnostic Accuracy of Prostate-specific Membrane Antigen Positron Emission Tomography and Conventional Imaging Modalities for Initial Staging of Intermediate- to High-risk Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol 2023; 84: 36-48
• 13 Sonni I, Felker ER, Lenis AT. et al. Head-to-head comparison of (68)Ga-PSMA-11 PET/CT and mpMRI with histopathology gold-standard in the detection, intra-prostatic localization and local extension of primary prostate cancer: results from a prospective single-center imaging trial. J Nucl Med 2022; 63: 847-854
• 14 Luining WI, Hagens MJ, Meijer D. et al. The Probability of Metastases Within Different Prostate-specific Antigen Ranges Using Prostatespecific Membrane Antigen Positron Emission Tomography in Patients with Newly Diagnosed Prostate Cancer. Eur Urol Open Sci 2024; 59: 55-62
• 15 Fendler WP, Eiber M, Beheshti M. et al. PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0. Eur J Nucl Med Mol Imaging 2023; 50: 1466-1486
• 16 Stabile A, Pellegrino A, Mazzone E. et al. Can Negative Prostatespecific Membrane Antigen Positron Emission Tomography/Computed Tomography Avoid the Need for Pelvic Lymph Node Dissection in Newly Diagnosed Prostate Cancer Patients?. A Systematic Review and Meta-analysis with Backup Histology as Reference Standard Eur Urol Oncol 2022; 5: 1-17
• 17 Amiel T, Würnschimmel C, Heck M. et al. Regional Lymph Node Metastasis on Prostate Specific Membrane Antigen Positron Emission Tomography Correlates with Decreased Biochemical Recurrence-Free and Therapy-Free Survival after Radical Prostatectomy: A Retrospective Single-Center Single-Arm Observational Study. J Urol 2021; 205: 1663-1670
• 18 Kesch C, Radtke J-P, Wintsche A. et al. Correlation between genomic index lesions and mpMRI and (68)Ga-PSMA-PET/CT imaging features in primary prostate cancer. Sci Rep 2018; 8: 16708
• 19 Kalapara AA, Nzenza T, Pan HYC. et al. Detection and localisation of primary prostate cancer using (68) gallium prostate-specific membrane antigen positron emission tomography/computed tomography compared with multiparametric magnetic resonance imaging and radical prostatectomy specimen pathology. BJU Int 2020; 126: 83-90
• 20 Jafarvand M, Farolfi A, Benz M. et al. PSMA PET/CT for prostate cancer patients after focal therapy: a single center retrospective analysis. J Nucl Med 2023; 64: P1241-P1241
• 21 Tarr GP, Kashyap P, Dixit DD. et al. Utility of Ga(68) prostate-specific membrane antigen positron-emission tomography for pre-operative staging of high-risk prostate cancer in a prospective cohort. J Med Imaging Radiat Oncol 2020; 64: 78-86
• 22 Ferraro DA, Garcia Schüler HI, Muehlematter UJ. et al. Impact of (68) Ga-PSMA-11 PET staging on clinical decision-making in patients with intermediate or high-risk prostate cancer. Eur J Nucl Med Mol Imaging 2020; 47: 652-664
• 23 Dewes S, Schiller K, Sauter K. et al. Integration of (68)Ga-PSMA-PET imaging in planning of primary definitive radiotherapy in prostate cancer: a retrospective study. Radiat Oncol 2016; 11: 73
• 24 Petit C, Delouya G, Taussky D. et al. PSMA-PET/CT-Guided Intensification of Radiation Therapy for Prostate Cancer (PSMAgRT): Findings of Detection Rate, Effect on Cancer Management, and Early Toxicity From a Phase 2 Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2023; 116: 779-787
• 25 Leitlinienprogramm Onkologie der Arbeitsgemeinschaft der Wissenschaftlichen Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Prostatakarzinom, Langversion 7.0, AWMF Registernummer: 043/022OL. 2024 Accessed October 29, 2024 at: http://www.leitlinienprogramm-onkologie.de/leitlinien/prostatakarzinom/
• 26 Cornford P, Tilki D, Bergh RCN van den. et al. EAU-EANM-ESTRO-ESURSIOG Guidelines on Prostate Cancer-2024. Eur Urol 2022; 79: 243-262
• 27 Ekmekcioglu Ö, Busstra M, Klass ND. et al. Bridging the Imaging Gap: PSMA PET/CT Has a High Impact on Treatment Planning in Prostate Cancer Patients with Biochemical Recurrence-A Narrative Review of the Literature. J Nucl Med 2019; 60: 1394-1398
• 28 Roach PJ, Francis R, Emmett L. et al. The Impact of (68)Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study. J Nucl Med 2018; 59: 82-88
• 29 Pozdnyakov A, Kulanthaivelu R, Bauman G. et al. The impact of PSMA PET on the treatment and outcomes of men with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26: 240-248
• 30 Freedland SJ, Almeida Luz M de, Giorgi U de. et al. Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer. N Engl J Med 2023; 389: 1453-1465
• 31 Armstrong WR. et al. PSMA PET findings in an “EMBARK-like” cohort of patients with high-risk non-metastatic hormone-sensitive prostate cancer: A single center post-hoc retrospective analysis. JCO 2023; 41: 5091-5091
• 32 Barbato F, Fendler WP, Rauscher I. et al. PSMA-PET for the assessment of metastatic hormone-sensitive prostate cancer volume of disease. J Nucl Med 2021; 62: 1747-1750
• 33 Perera M, Papa N, Roberts M. et al. Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigen-avid Lesions: A Systematic Review and Meta-analysis. Eur Urol 2020; 77: 403-417
• 34 Phillips R, Shi WY, Deek M. et al. Outcomes of Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer: The ORIOLE Phase 2 Randomized Clinical Trial. JAMA Oncol 2020; 6: 650-659
• 35 Francini E, Gray KP, Xie W. et al. Time of metastatic disease presentation and volume of disease are prognostic for metastatic hormone sensitive prostate cancer (mHSPC). Prostate 2018; 78: 889-895
• 36 Sweeney CJ, Chen Y-H, Carducci M. et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med 2015; 373: 737-746
• 37 Fizazi K, Tran N, Fein L. et al. Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 2017; 377: 352-360
• 38 Gandaglia G, Karakiewicz PI, Briganti A. et al. Impact of the Site of Metastases on Survival in Patients with Metastatic Prostate Cancer. Eur Urol 2015; 68: 325-334
• 39 Nieuwenhove S van, Damme J van, Padhani AR. et al. Whole-body magnetic resonance imaging for prostate cancer assessment: Current status and future directions. J Magn Reson Imaging 2022; 55: 653-680
• 40 Fanti S, Minozzi S, Castellucci P. et al. PET/CT with (11)C-choline for evaluation of prostate cancer patients with biochemical recurrence: meta-analysis and critical review of available data. Eur J Nucl Med Mol Imaging 2016; 43: 55-69
• 41 Thomas L, Balmus C, Ahmadzadehfar H. et al. Assessment of Bone Metastases in Patients with Prostate Cancer-A Comparison between (99 m)Tc-Bone-Scintigraphy and (68)GaGa-PSMA PET/CT. Pharmaceuticals (Basel) 2017; 10: 68
• 42 Hoeh B, Garcia CC, Wenzel M. et al. Triplet or Doublet Therapy in Metastatic Hormone-sensitive Prostate Cancer: Updated Network Metaanalysis Stratified by Disease Volume. Eur Urol Focus 2023; 9: 838-842
• 43 Fendler WP, Weber M, Iravani A. et al. Prostate-Specific Membrane Antigen Ligand Positron Emission Tomography in Men with Nonmetastatic Castration-Resistant Prostate Cancer. Clin Cancer Res 2019; 25: 7448-7454
• 44 Sartor O, Bono J de, Chi KN. et al. Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer. N Engl J Med 2021; 385: 1091-1103
• 45 Seifert R, Seitzer K, Herrmann K. et al. Analysis of PSMA expression and outcome in patients with advanced Prostate Cancer receiving (177) Lu-PSMA-617 Radioligand Therapy. Theranostics 2020; 10: 7812-7820
• 46 Hartrampf PE, Serfling SE, Michalski K. et al. PSMA PET/CT for Response Assessment of (177)Lu-PSMA Therapy. Seminars in Nuclear Medicine 2024; 54: 69-76
• 47 Seitz AK, Rauscher I, Haller B. et al. Preliminary results on response assessment using (68)Ga-HBED-CC-PSMA PET/CT in patients with metastatic prostate cancer undergoing docetaxel chemotherapy. Eur J Nucl Med Mol Imaging 2018; 45: 602-612
• 48 Grubmüller B, Senn D, Kramer G. et al. Response assessment using (68)Ga-PSMA ligand PET in patients undergoing (177)Lu-PSMA radioligand therapy for metastatic castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging 2019; 46: 1063-1072
• 49 Kind F, Eder A-C, Jilg CA. et al. Prognostic Value of Tumor Volume Assessment on PSMA PET After (177)Lu-PSMA Radioligand Therapy Evaluated by PSMA PET/CT Consensus Statement and RECIP 1.0. J Nucl Med 2023; 64: 605-610
• 50 Schmuck S, Klot CA von, Henkenberens C. et al. Initial Experience with Volumetric (68)Ga-PSMA I & T PET/CT for Assessment of Whole-Body Tumor Burden as a Quantitative Imaging Biomarker in Patients with Prostate Cancer. J Nucl Med 2017; 58: 1962-1968