PSMA PET in Prostate Cancer: Clinical Value, Access Challenges, and Priorities for Implementation.

Abstract

Prostate-specific membrane antigen positron emission tomography (PSMA PET) has become an integral component of contemporary prostate cancer (PCa) management, improving disease characterization in clinically relevant settings such as initial staging of higher-risk disease and biochemical recurrence. Beyond its superior diagnostic performance compared with conventional imaging, PSMA PET increasingly influences treatment planning, patient stratification, and multidisciplinary decision-making. However, despite growing incorporation into international clinical guidelines, access to PSMA PET remains heterogeneous across health care systems. Variability in reimbursement policies, regulatory frameworks, tracer availability, imaging capacity, referral pathways, and local expertise may limit timely access for eligible patients. These disparities have important clinical implications, potentially affecting staging accuracy, localization of recurrent disease, treatment selection, and equity of care. In this expert perspective, we discuss the evolving role of PSMA PET in PCa management, highlight the clinical consequences of unequal access, and identify key priorities to facilitate implementation across Europe. Improving access to high-quality PSMA PET should be regarded not only as a logistical objective but also as a clinical priority to ensure that advances in molecular imaging translate into more precise, timely, and equitable PCa care.