Saad Aad, Ribal Houmani, Jad Houmani, Christie Saad, Hagop Sassounian, Lamia Daouk, Carl Karam, Mohamad Houmani
Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has transformed the imaging approach to prostate cancer (PCa) by enabling biologically targeted detection of disease beyond the capabilities of conventional anatomical imaging. This review examines the clinical impact of PSMA-PET in primary staging, detection of biochemical recurrence, and treatment decision-making, and discusses its integration into contemporary clinical practice. Compared with computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy, PSMA-PET demonstrates superior diagnostic accuracy for identifying nodal and distant metastatic disease, particularly in patients with intermediate- and high-risk tumors. In newly diagnosed disease, improved detection of small-volume metastases frequently alters treatment intent and guides the selection of local or systemic therapies. In the setting of biochemical recurrence, detection rates correlate strongly with prostate-specific antigen (PSA) levels, allowing earlier localization of recurrent disease and more individualized salvage strategies. PSMA-PET findings increasingly influence radiotherapy planning, selection of metastasis-directed therapies, and eligibility for targeted treatments. Major clinical guidelines now incorporate PSMA-PET into recommended staging and recurrence evaluation pathways. Despite these advances, important limitations remain, including false-positive findings, variability in interpretation, incomplete histologic confirmation, and limited evidence linking imaging-guided management changes to improved long-term outcomes. PSMA-PET represents a major advance in prostate cancer imaging by improving staging accuracy and enabling more personalized treatment strategies, while ongoing prospective studies aim to clarify its impact on survival and quality of care.