ESUR: Opportunities for PSMA-PET/CT and whole-body MRI in advanced prostate cancer - Special Report

Sep 23, 2026

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computed tomography (CT) and whole-body magnetic resonance imaging (WB-MRI) offer higher accuracy than conventional CT and bone scan imaging for detecting metastatic prostate cancer. The work emphasizes the need to connect evolving treatment approaches with conventional disease-volume measures and the prognostic meaning of prostate-specific antigen (PSA) response. Prospective trials are required to test whether these imaging biomarkers improve clinically relevant endpoints through more precise treatment adaptation.

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Abstract

Key Points

Introduction

Management landscape of mHSPC

Woo et al. European Radiology (2026) 36:2794–2812 [https://doi.org/10.1007/s00330-025-12089-9](https://doi.org/10.1007/s00330-025-12089-9) SPECIAL REPORT Open Access ESUR: Opportunities for PSMA-PET/CT and whole-body MRI in advanced prostate cancer Sungmin Woo 1, Luca Russo2,3, Samuel J. Withey4, Ailin Dehghanpour5,6, Roberto García-Figueiras7, Ivo G. Schoots8,9, Giuseppe Petralia 10,11, Amish Lakhani 12, Tobias Penzkofer 13,14, Martina Pecoraro5, Chen-Jiang Wu 15, Jochen Walz 16, Matthias Eiber 17, Wolfgang P. Fendler 18,19, Silke Gillessen20,21, Raquel Perez-Lopez22, Frédéric E. Lecouvet23, Tara D. Barwick24 and Anwar R. Padhani 12* on behalf of the ESUR Prostate MRI Working Group Abstract Prostate-speciﬁc membrane antigen (PSMA) positron emission tomography (PET) computed tomography (CT), and whole-body magnetic resonance imaging (WB-MRI) are superior to conventional CT and bone scan imaging for detecting metastatic disease in patients with prostate cancer. While these higher-accuracy imaging methods have already shown the potential to enhance patient outcomes, a thorough understanding of the relationship between the treatment landscape and disease volume on conventional imaging, as well as the prognostic signiﬁcance of the prostate-speciﬁc antigen response, is crucial for determining how they can be more effectively incorporated. Prospective clinical trials are required to evaluate whether PSMA-PET/CT and WB-MRI can genuinely improve clinically relevant endpoints for patients through precise treatment adaptations. In this paper, we explore the speciﬁc opportunities of PSMA-PET/CT and WB-MRI as biomarkers in multiple clinical domains, including metastasis detection and staging, disease characterisation and aggressiveness assessments, biopsy target selection, impacts on treatment planning, evaluation of therapeutic response, and theranostics. We highlight the central research questions that require attention. Key Points Question Can PSMA-PET/CT and WB-MRI, with their superior ability to detect metastases in prostate cancer, truly improve patient outcomes? Findings High-accuracy imaging improves metastasis detection, staging, assessment of disease aggressiveness, and enables more personalised treatment planning for advanced prostate cancer patients. Clinical relevance PSMA-PET/CT and WB-MRI have the potential to alter the management of men with advanced prostate cancer, but prospective clinical trials are needed to conﬁrm beneﬁts for survival or quality of life before recommending routine use. Keywords Advanced prostate cancer, Prostate speciﬁc membrane antigen positron emission tomography, Wholebody magnetic resonance imaging, Metastasis *Correspondence: Anwar R. Padhani [anwar.padhani@stricklandscanner.org.uk](anwar.padhani@stricklandscanner.org.uk) Full list of author information is available at the end of the article © The Author(s) 2025 . Open Access This article is licensed under a Creative Commons Attribution 4 . 0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/](http://creativecommons.org/)[ ](http://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/.)[.](licenses/by/4.0/.) Introduction Advanced prostate cancer (APC) refers to locally advanced prostate cancer (PCa), metastat

FAQs

What clinical problem do PSMA-PET/CT and WB-MRI aim to improve in advanced prostate cancer?

They target more accurate detection of metastatic disease compared with conventional CT and bone scan imaging, supporting staging and clinical decision-making.

Why are prospective clinical trials necessary for these imaging methods?

Because improved detection and accuracy must be proven to translate into clinically relevant endpoints, such as survival or quality of life, through precise treatment adaptations.

In which clinical domains are PSMA-PET/CT and WB-MRI discussed as biomarkers?

They are explored for metastasis detection and staging, disease characterisation and aggressiveness assessment, biopsy target selection, treatment planning, therapeutic response evaluation, and theranostics.

Sep 23, 2026

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