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Is there a role of PSMA-PET in focal therapy planning and follow-up?

Prostate Cancer and Prostatic Diseases (2025)Cite this article

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Abstract

Introduction

Focal therapy (FT) is a promising alternative to radical treatments for localized Prostate Cancer (PCa) in selected patients. However, it is not yet considered a standard treatment option, and there is currently no consensus on managing patients after FT. In this context, Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) may support multiparametric MRI (mpMRI) for both pre-operative planning and follow-up. The aim of this systematic review was to provide a comprehensive overview of the current applications of PSMA-PET in the field of FT and to analyze its future perspectives.

Evidence acquisition

A literature search was performed using PubMed and Scopus databases, following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. All studies reporting data on PSMA-PET performed before and/or after FT for PCa were included. A narrative synthesis was employed to summarize the review findings. No quantitative synthesis was performed due to the heterogeneity and limitations of the studies.

Evidence synthesis

Seven studies (2 case reports, 1 retrospective, and 4 prospective single-center studies) were included in this review. A moderate-severe risk of bias was assessed for the included studies. In the field of FT, PSMA-PET showed promising but yet not validated results with several possible applications: (1) pre-operative planning and staging, aiming to improve patient selection trough the identification of intraprostatic suspected lesions and more accurate local and systemic staging; (2) guidance for biopsy and Region of Interest (ROI) definition; (3) follow-up imaging tool, aiming to decrease the number of unnecessary surveillance biopsies.

Conclusions

Limited evidence exists regarding the use of PSMA-PET in the field of FT, considering pre-operative setting, treatment guidance and its use as a non-invasive tool to evaluate treatment success or failure and for follow-up. In this scenario, even if the current evidence is still limited and inconclusive, PSMA-PET showed promising results with several possible applications.

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The online version contains supplementary material, including the list of all articles retrieved and tables reporting information about these studies.

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Author information

Author notes

  1. These authors contributed equally: Rossella Nicoletti, Andrea Alberti

Authors and Affiliations

  1. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Rossella Nicoletti, Andrea Alberti, Elena Ciaralli, Francesco Sessa, Sergio Serni, Riccardo Campi & Mauro Gacci

  2. S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

    Rossella Nicoletti, Chi Hang Yee, Peter Chiu, David Leung, Antony Chi Fai Ng & Jeremy Yuen Chun Teoh

  3. Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy

    Rossella Nicoletti, Andrea Alberti, Elena Ciaralli, Francesco Sessa, Sergio Serni, Riccardo Campi & Mauro Gacci

  4. Ng Teng Fong General Hospital, NUHS, Singapore, Singapore

    Vineet Gauhar

  5. Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy

    Daniele Castellani

  6. Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece

    Theodoros Tokas

  7. Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria

    Theodoros Tokas

  8. University Hospital Southampton NHS Trust, Southampton, UK

    Bhaskar Somani

  9. Rabin Medical Center (Belenson, Hasharon), Petah Tikva, Israel

    Dmitry Enikeev

  10. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Dmitry Enikeev

  11. Vienna Medical University, Vienna, Austria

    Dmitry Enikeev

  12. Institute for Urology and Reproductive Health, Moscow, Russia

    Dmitry Enikeev

  13. Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK

    Nikhil Vasdev

  14. School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK

    Nikhil Vasdev

  15. Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Jeremy Yuen Chun Teoh

  16. Department of Urology, Medical University of Vienna, Vienna, Austria

    Jeremy Yuen Chun Teoh

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Contributions

AA, RN and VG were responsible for interpreting data, editing and revising the tables, assessing risk of bias, and writing the paper. EC, DC, DL, were responsible for collecting and reviewing journal articles, editing summary tables, and editing the manuscript. RC, JYCT and were responsible for designing the review protocol, coordinating the group, and supervising the project. FS, SS, MG, CHY, PC, BS TT, DE, NV an ACFN provided feedback on the manuscript.

Corresponding author

Correspondence to Jeremy Yuen Chun Teoh.

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The authors declare no competing interests.

Ethics approval and consent to participate

As this is a systematic review, institutional review board or patient consent were not required. As for all systematic reviews, the patients presented in this systematic review have been previously reported.

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Appendix

Appendix

Section 1. Literature Search strategy

Database: PubMed

Search Strategy: focal brachytherapy OR Irreversible Electroporation OR High-Intensity Focused Ultrasound OR cryotherapy OR microwave ablation OR partial prostatectomy OR focal laser therapy OR photodynamic therapy OR radio- frequency ablation AND (prostat OR prostatic) AND (PET PSMA)

Database: Scopus

Search Strategy: TITLE-ABS-KEY (focal AND brachytherapy OR irreversible AND electroporation OR high-intensity AND focused AND ultrasound OR cryotherapy OR microwave AND ablation OR partial AND prostatectomy OR focal AND laser AND therapy OR photodynamic AND therapy OR radiofrequency AND ablation) AND (prostate OR prostatic) AND (pet OR psma)

Section 2. List of included papers

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Nicoletti, R., Alberti, A., Gauhar, V. et al. Is there a role of PSMA-PET in focal therapy planning and follow-up?. Prostate Cancer Prostatic Dis (2025). https://doi.org/10.1038/s41391-025-00944-1

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