Since its introduction into clinical prostate cancer imaging little more than a decade ago, PSMA PET/CT has undergone a remarkable transformation from a promising but relatively niche molecular imaging technique to an integral part of contemporary prostate cancer management.

Early studies with ⁶⁸Ga-labelled PSMA ligands demonstrated the ability of PSMA PET/CT to detect prostate cancer lesions with substantially greater sensitivity than conventional imaging, particularly in the case of biochemical recurrence. This rapidly expanding evidence base was followed by prospective trials such as ProPSMA, which demonstrated superior accuracy of PSMA PET/CT over conventional CT and bone scintigraphy for the initial staging of high-risk disease, together with a greater impact on management. These data have progressively moved PSMA PET/CT from the periphery of prostate cancer diagnostics into routine clinical practice^[i], with contemporary international guidelines supporting its use for initial staging, localisation of recurrent disease and assessment before PSMA-directed radioligand therapy.

However, the most recent developments suggest that its role may extend considerably beyond performing a single diagnostic examination at a particular point in the disease course. PSMA PET/CT is increasingly becoming a longitudinal imaging tool, useful to be repeated as the disease evolves in order to adjust the treatment. The value of this approach is illustrated by two recent studies:

1. repeat imaging can reveal clinically meaningful disease that was not identified on the initial examination, thereby changing subsequent management – “More than half of patients with biochemical failure after primary therapy for prostate cancer who have an initial negative PSMA PET/CT scan may have disease identified on a second PSMA PET/CT scan. The impact of a second PSMA PET/CT scan remains high, with management change necessary for nearly 50% of patients. A second PSMA PET/CT scan after an initially negative scan is more likely to be informative among patients with a PSA greater than 0.5 ng/mL or a PSA doubling time of less than 12 mo.”^[1]
2. repeat imaging after initiation of androgen-receptor pathway inhibition can demonstrate treatment-induced changes in PSMA expression and, importantly, reveal differences in the biological behaviour of individual tumours that may influence the suitability and potential benefit of PSMA-targeted radioligand therapy.^[2]

In this context, the second PSMA PET/CT is not simply a confirmation of the first scan, but can provide new biological and clinical information that emerges with time and treatment.

Together, these developments support a shift in perspective: rather than considering PSMA PET/CT as a test performed once for staging or once when biochemical recurrence occurs, it may increasingly be viewed as a diagnostic tool that accompanies the patient throughout the disease trajectory: initial staging, restaging at recurrence, reassessment of disease biology during systemic treatment, and selection or adaptation of subsequent therapies.

At MINUTEmedical, we have been applying this approach in clinical practice for many years, allowing us to respond promptly and tailor treatment to changes in each patient’s disease course.

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^[1] Ur Metser, Glenn Bauman, Mohammed Rashid, et al.; Utility of PSMA PET/CT After an Initial Negative Scan: Results from a Prospective Multicenter PSMA PET Registry; Journal of Nuclear Medicine, Jul 2026, 67 (7) 1097-1101; DOI: 10.2967/jnumed.126.272204

^[2] Emmett, L., Swiha, M., Papa, N. et al. Predictive value of early PSMA upregulation for the response to enzalutamide ± ¹⁷⁷Lu-PSMA-617 in poor-risk, metastatic, castration-resistant prostate cancer: substudy of the randomized, phase 2 ENZA-p trial. Nat Cancer 7, 622–630 (2026). https://doi.org/10.1038/s43018-026-01140-3

^[i] PSMA PET Adoption Timeline: