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Therapeutic targeting of prostate-specific membrane antigen could limit its potential as benchmark imaging

Prostate-specific membrane antigen (PSMA) as a theranostic agent is driving changes in prostate cancer including both clinical development of new drugs and clinical care. The sensitivity of PSMA imaging has created impatience in industry and the clinic alike to replace traditional computed tomography and bone scan in clinical practice and drug development. However, the success of PSMA as a therapeutic target might limit the ability of PSMA imaging to adequately define prostate cancer in a therapeutic landscape where highly effective PSMA-based therapies are used early in the disease course.

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Fig. 1: The emergence of PSMA dark disease might limit the sensitivity of subsequent PSMA imaging.

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Correspondence to Ravi A. Madan.

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Abel, M.L., Sharp, A., Posadas, E.M. et al. Therapeutic targeting of prostate-specific membrane antigen could limit its potential as benchmark imaging. Nat Rev Urol (2025). https://doi.org/10.1038/s41585-025-01100-z

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