{"entity":{"id":"paper-jadvar-snmmi-psma-auc-jnm-2022","kind":"paper","name":"Appropriate use criteria for prostate-specific membrane antigen (PSMA) PET imaging","aka":[],"tldr":"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).\n\nPSMA 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.\n\nThe 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.","asOf":"2026-09-22","links":[{"label":"SNMMI: PSMA PET Appropriate Use Criteria (PDF)","url":"https://snmmi.org/common/Uploaded%20files/Web/Clinical%20Practice/Appropriate%20Use%20Criteria/PSMA%20AUC%202022.03.15_final_BOD%20approved.pdf"},{"label":"SNMMI: AUC overview page","url":"https://snmmi.org/Web/Web/Clinical-Practice/Appropriate-Use-Criteria/Articles/Appropriate-Use-Criteria-for-Prostate-Specific-Membrane-Antigen--PSMA--PET-Imaging.aspx"}],"tags":["guideline","PSMA PET","appropriate use criteria"],"related":["psma-pet","ga68-psma-11","pylarify","prostate","prostate-bcr","prostate-mcrpc","psma-pet-to-rlt","eanm","snmmi","jeremie-calais","f-18","ga-68"],"indications":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"journal":"Journal of Nuclear Medicine","year":2022,"doi":"10.2967/jnumed.121.263262","pmid":"34531258","authors":"Jadvar H, Calais J, Fanti S, Feng F, Greene KL, et al.","paperType":"guideline","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."],"whatItMeans":"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."],"changedPractice":true},"route":"/key-papers/paper-jadvar-snmmi-psma-auc-jnm-2022/","neighbours":{"technology":[{"id":"psma-pet","kind":"technology","name":"PSMA PET","route":"/technologies/psma-pet/"}],"drug":[{"id":"ga68-psma-11","kind":"drug","name":"Gallium-68 gozetotide (PSMA-11)","route":"/drugs/ga68-psma-11/"},{"id":"pylarify","kind":"drug","name":"Piflufolastat F-18 / Pylarify TruVu","route":"/drugs/pylarify/"}],"indication":[{"id":"prostate-bcr","kind":"indication","name":"Biochemical recurrence of prostate cancer","route":"/indications/prostate-bcr/"},{"id":"prostate-mcrpc","kind":"indication","name":"Metastatic castration-resistant prostate cancer","route":"/indications/prostate-mcrpc/"},{"id":"prostate","kind":"indication","name":"Prostate cancer","route":"/indications/prostate/"}],"pairing":[{"id":"psma-pet-to-rlt","kind":"pairing","name":"PSMA PET → PSMA radioligand therapy","route":"/pairings/psma-pet-to-rlt/"}],"institution":[{"id":"eanm","kind":"institution","name":"European Association of Nuclear Medicine","route":"/institutions/eanm/"},{"id":"snmmi","kind":"institution","name":"Society of Nuclear Medicine and Molecular Imaging","route":"/institutions/snmmi/"}],"person":[{"id":"jeremie-calais","kind":"person","name":"Jeremie Calais","route":"/people/jeremie-calais/"}],"isotope":[{"id":"f-18","kind":"isotope","name":"Fluorine-18","route":"/isotopes/f-18/"},{"id":"ga-68","kind":"isotope","name":"Gallium-68","route":"/isotopes/ga-68/"}]}}