# Appropriate use criteria for prostate-specific membrane antigen (PSMA) PET imaging

Source: https://nuclide.cc/key-papers/paper-jadvar-snmmi-psma-auc-jnm-2022/  
Nuclide record `paper-jadvar-snmmi-psma-auc-jnm-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

A panel of cancer and imaging specialists agreed, scenario by scenario, when a PSMA PET scan for prostate cancer is a good idea and when it usually is not - a reference clinicians and insurers use to decide who should get the scan.

## Summary

Following FDA approval of the first PSMA PET tracers (68Ga-PSMA-11 and 18F-DCFPyL) in 2020-2021, SNMMI convened a multidisciplinary panel - with the American College of Nuclear Medicine, American Urological Association, ANZSNM, ASCO, EANM and American College of Physicians - to produce appropriate use criteria (AUC) for PSMA PET in prostate cancer, using a RAND/UCLA-style consensus process. The panel scored defined clinical scenarios from 1 (rarely appropriate) to 9 (appropriate).

PSMA PET was rated appropriate (score 8-9) for staging newly diagnosed unfavourable-intermediate, high- or very-high-risk prostate cancer (including when conventional imaging is negative or equivocal), for working up a PSA rise after prostatectomy or radiotherapy (biochemical recurrence), for non-metastatic castration-resistant disease on conventional imaging, and - critically - for confirming eligibility for PSMA-targeted radioligand therapy (score 9). It was rated rarely appropriate (score 2-3) for detecting or characterising the primary tumour in men with suspected but unbiopsied prostate cancer, or in very low/low/favourable-intermediate risk disease.

The document became the reference used by payers and referring clinicians to decide when a PSMA PET scan is billable and clinically justified, and its scenario 11 (eligibility for PSMA radioligand therapy) directly operationalises how VISION- and TheraP-style PET selection criteria are applied in routine practice.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Tags: guideline; PSMA PET; appropriate use criteria
- Journal: Journal of Nuclear Medicine
- Year: 2022
- DOI: 10.2967/jnumed.121.263262
- Authors: Jadvar H, Calais J, Fanti S, Feng F, Greene KL, et al.
- Findings: PSMA PET rated appropriate (score 8) for staging newly diagnosed unfavourable-intermediate, high- or very-high-risk prostate cancer.; PSMA PET rated appropriate (score 9) for PSA rise after prostatectomy or radiotherapy (biochemical recurrence) and for confirming eligibility for PSMA-targeted radioligand therapy.; PSMA PET rated rarely appropriate (score 2-3) for detecting intraprostatic tumour in men with suspected but unbiopsied cancer, and for very low/low/favourable-intermediate-risk disease.; Panel included representatives from SNMMI, American College of Nuclear Medicine, American College of Physicians, ASCO, American Urological Association, ANZSNM and EANM.
- What it means: This guideline tells doctors and insurers exactly which clinical situations justify a PSMA PET scan for prostate cancer - mainly staging higher-risk disease, investigating a PSA rise after treatment, and checking that a patient's cancer will respond to PSMA radioligand therapy - and which situations do not.
- Caveats: Appropriate use criteria reflect expert consensus and the evidence available in 2022; they are updated periodically and score some scenarios only as 'may be appropriate', reflecting genuine uncertainty rather than a firm answer.; Scores were assigned per clinical scenario, not per specific PSMA tracer; the panel treated different PSMA PET agents as broadly equivalent.

## Sources

- SNMMI: PSMA PET Appropriate Use Criteria (PDF): https://snmmi.org/common/Uploaded%20files/Web/Clinical%20Practice/Appropriate%20Use%20Criteria/PSMA%20AUC%202022.03.15_final_BOD%20approved.pdf
- SNMMI: AUC overview page: https://snmmi.org/Web/Web/Clinical-Practice/Appropriate-Use-Criteria/Articles/Appropriate-Use-Criteria-for-Prostate-Specific-Membrane-Antigen--PSMA--PET-Imaging.aspx

## Connected records

- technologies: [PSMA PET](https://nuclide.cc/technologies/psma-pet/)
- drugs: [Gallium-68 gozetotide (PSMA-11)](https://nuclide.cc/drugs/ga68-psma-11/), [Piflufolastat F-18 / Pylarify TruVu](https://nuclide.cc/drugs/pylarify/)
- indications: [Biochemical recurrence of prostate cancer](https://nuclide.cc/indications/prostate-bcr/), [Metastatic castration-resistant prostate cancer](https://nuclide.cc/indications/prostate-mcrpc/), [Prostate cancer](https://nuclide.cc/indications/prostate/)
- pairings: [PSMA PET → PSMA radioligand therapy](https://nuclide.cc/pairings/psma-pet-to-rlt/)
- institutions: [European Association of Nuclear Medicine](https://nuclide.cc/institutions/eanm/), [Society of Nuclear Medicine and Molecular Imaging](https://nuclide.cc/institutions/snmmi/)
- people: [Jeremie Calais](https://nuclide.cc/people/jeremie-calais/)
- isotopes: [Fluorine-18](https://nuclide.cc/isotopes/f-18/), [Gallium-68](https://nuclide.cc/isotopes/ga-68/)

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