PSMA PET
A prostate-cancer-specific PET scan that finds spread far earlier than CT or bone scan, and tells you whether a matched radioactive drug will work.
Overview
PSMA PET uses small-molecule urea-based ligands that bind the active site of prostate-specific membrane antigen and are internalised, labelled with 68Ga or 18F. Approved agents are 68Ga-PSMA-11 (Illuccix, Locametz), 18F-DCFPyL (Pylarify, with Pylarify TruVu approved in March 2026) and 18F-rhPSMA-7.3 (Posluma). In clinical use since 2020, it is standard for initial staging of high-risk disease and for biochemical recurrence, where it detects disease at PSA below 0.5 ng/mL, far earlier than CT or bone scan. It is also the theranostic gatekeeper: a PSMA-positive scan is required to select patients for 177Lu-PSMA-617, as in VISION and PSMAfore. Around 10% of patients have PSMA-negative disease, and uptake in ganglia and salivary glands can be mistaken for tumour. It finds spread early and predicts whether the matched radioactive drug will work.
- Detector ring
- PSMA ligand
- 511 keV photon pair
How it works
Small-molecule urea-based ligands bind PSMA's active site and are internalised.
- Detects recurrence at PSA <0.5 ng/mL
- Theranostic gatekeeper
- PSMA-negative disease in ~10%
- Uptake in ganglia, salivary glands
Dependencies
Open the dependency map →Dependencies are what this technology cannot be delivered without: manufacturing steps, instruments, software, upstream methods. See its full chain on the map.
177Lu-PSMA-I&T is a second PSMA radioligand, chemically different from Pluvicto, that has passed two phase 3 trials on progression but has not yet shown a survival benefit.
Choline C-11 was the first PET tracer approved in the United States, in 2012, to find where prostate cancer has come back when PSA rises after treatment; PSMA tracers have now largely replaced it.
An experimental PET tracer for prostate cancer that binds the same target as approved PSMA scans (PSMA) but, because its radioactive tag lasts longer, can be re-imaged a day later to catch small deposits the first picture missed. It is not yet approved for sale.
Florastamin is FutureChem's fluorine-18 PSMA PET tracer, and the first prostate cancer diagnostic developed in South Korea to be approved there — Korea's 43rd domestically developed new drug.
Flotufolastat is a third PSMA PET tracer, with a radiohybrid chemistry designed to be reused for therapy.
Gallium-68 PSMA-11 was the first PSMA PET tracer approved in the US (2020), and is made on site from a generator or cyclotron.
Telix's ready-to-label kit that lets any nuclear medicine department make the gallium PSMA scan for prostate cancer.
Novartis' gallium PSMA scan kit, approved the same day as Pluvicto as the test that qualifies men for that radioactive drug.
A radioactive drug that seeks out PSMA on prostate cancer cells; the best-selling radiopharmaceutical ever.
Piflufolastat F-18 (Pylarify) is the leading PSMA PET tracer for prostate cancer, with a new formulation approved in March 2026.
PSMA-1007 is a fluorine-18 PSMA PET tracer from ABX in Germany, widely used in Europe for prostate cancer staging because little of it reaches the bladder, and in a phase 3 trial registered by its maker.
For men who still have a working hormone treatment option but whose cancer is progressing, offering the PSMA radioligand therapy sooner - before chemotherapy - delayed disease progression, though it did not clearly extend how long men lived once the very high rate of patients switching over is accounted for.
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.
For men whose prostate cancer has grown after chemotherapy, a PSMA-targeted radioactive treatment worked at least as well as, and was gentler than, the chemotherapy drug it replaced - provided a PET scan first confirms the cancer takes up the PSMA tracer.
Men with metastatic castration-resistant prostate cancer that has progressed after hormonal therapy and chemotherapy, and whose tumours show PSMA on a PET scan, can now receive lutetium-PSMA, which extends life, controls pain and is usually better tolerated than further chemotherapy. It has established a new treatment class in which a scan decides who gets the matching radioactive drug, and it is now being tested earlier in the disease (PSMAfore, PSMAddition).
In a small early trial, most heavily pre-treated men with advanced prostate cancer responded to the PSMA-targeted radioactive drug, with manageable side effects, supporting the case for testing it in larger randomised trials.
Latest papers
topQuery for this technology: (TITLE:"PSMA PET" OR ABSTRACT:"PSMA PET" OR TITLE:"PSMA PET/CT" OR ABSTRACT:"PSMA PET/CT" OR TITLE:"68Ga-PSMA" OR ABSTRACT:"68Ga-PSMA" OR TITLE:"18F-DCFPyL" OR ABSTRACT:"18F-DCFPyL"). Results are unfiltered search hits about PSMA PET, not a curated reading list.
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