Indikationen zur Durchführung der PSMA-PET-CT im Rahmen der Prostatakarzinomdiagnostik

Zusammenfassung

Hintergrund

Die Positronenemissionstomografie/Computertomografie mit prostataspezifischen Membranantigenen (PSMA-PET/CT) findet zunehmende Anwendung in der Diagnostik des Prostatakarzinoms.

Ziel der Arbeit/Fragestellung

Ziel dieses Reviews ist die Darstellung und Bewertung etablierter und innovativer Indikationen für die PSMA-PET/CT-Bildgebung.

Material und Methoden

Hintergrundwissen zur PSMA-PET/CT und behandlungsrelevante Leitlinienempfehlungen werden veranschaulicht und durch aktuelle Studienergebnisse ergänzt.

Ergebnisse

Die PSMA-PET/CT zeigt sich der konventionellen Bildgebung überlegen und kann in allen Stadien des Prostatakarzinoms je nach Indikation komplementär oder substitutiv eingesetzt werden. Sie bietet Vorteile in Form eines reduzierten Zeitaufwands und einer geringeren Strahlenbelastung. Der Einsatz der PSMA-PET/CT ermöglicht eine verbesserte Einschätzung des Krankheitsstatus und eine optimierte Therapieplanung. Ihre Anwendung erstreckt sich dabei vom initialen Karzinomverdacht über Diagnose und Staging bis hin zur Therapieplanung beim biochemischen Rezidiv und metastasiertem Prostatakarzinom. Derzeit fehlen jedoch Belege für den prognostischen Wert PSMA-PET/CT-basierter Therapieentscheidungen.

Schlussfolgerung

Die PSMA-PET/CT bietet einen signifikanten diagnostischen und therapeutischen Mehrwert für viele Prostatakarzinompatienten. Ihr Einsatz unterstützt die Evaluierung möglicher Intensivierungs- oder Deeskalationsstrategien und ermöglicht so eine personalisierte Therapieplanung.

Abstract

Background

Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) is increasingly being applied in the diagnostic landscape of prostate cancer.

Objective

This study aims to elucidate and assess both established and emerging indications for PSMA-PET/CT imaging.

Materials and methods

Current evidence on PSMA-PET/CT is summarised, with relevant guideline recommendations and enhanced by recent study findings.

Results

PSMA-PET/CT demonstrates superiority over conventional imaging techniques and can be applied either complementarily or substitutively across all stages of prostate cancer based on clinical indications. It offers advantages in terms of reduced time and radiation exposure. PSMA-PET/CT use enables a more accurate assessment of disease status and facilitates optimised treatment planning. Applications span from initial cancer suspicion through diagnosis, staging, and therapeutic planning in cases of biochemical recurrence and metastatic prostate cancer. However, evidence for the prognostic value of PSMA-PET/CT-guided therapy decisions is currently limited.

Conclusion

PSMA-PET/CT provides substantial diagnostic and therapeutic benefits for nearly all subgroups of prostate cancer patients. Its use supports the evaluation of possible intensification or de-escalation strategies, thereby enabling personalised treatment planning.

Schlüsselwörter

PSMA-PET/CT - Prostatakarzinom - Risikostratifizierung - Therapiesteuerung - metastasendirektive Therapie

Keywords

PSMA-PET/CT - prostate cancer - risk stratification - therapy guidance - metastasis-directed therapy

Publication History

Received: 05 November 2024

Accepted after revision: 21 January 2025

Article published online:
18 March 2025

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