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Medically Approved by Dr Aqua Asif (Jun 18th 2025) and Mr Raj Nigam Consultant Urologist GMC: 3265226
Written by FTC Medical team
At a Glance
A PSMA PET scan is an advanced imaging test that detects prostate cancer cells throughout the body by targeting a protein (PSMA) found on their surface. It can identify cancer at PSA levels as low as 0.2 ng/mL — far earlier than conventional bone scans or CT. At The Focal Therapy Clinic, PSMA PET scanning is part of our diagnostic workup to confirm whether cancer is truly localised before recommending focal therapy.
Targets cancer cells directly — uses a radioactive tracer that binds to PSMA, a protein overexpressed on prostate cancer cells
Detects spread earlier— identifies metastases and recurrence at PSA levels as low as 0.2 ng/mL, when other scans may miss them
Changes treatment plans — the landmark proPSMA trial (Hofman et al., Lancet, 2020) showed management changed in 28% of cases
Guides focal therapy decisions — helps confirm that cancer is localised supporting treatments like HIFU (NICE IPG424) or NanoKnife IRE (NICE IPG768)
Safe and well-tolerated — outpatient procedure taking 2–3 hours, with the tracer cleared naturally through urine within 24 hours
What Is PSMA and Why Does It Matter?
PSMA (prostate-specific membrane antigen) is a protein found on the surface of prostate cells. Prostate cancer cells produce significantly more PSMA than healthy cells, making it an ideal target for advanced imaging. A PSMA PET scan exploits this difference to locate cancer cells throughout the body with greater precision than conventional scans.
PSMA is a protein found on the surface of all prostate cells, but cancer cells typically produce it in far greater quantities. This overexpression makes PSMA a reliable biomarker — a biological signal that can be targeted by specially designed radioactive tracers used in PET scanning.
Research shows PSMA levels tend to increase as prostate cancer becomes more aggressive (Wright et al., Urol Oncol, 1995). By identifying where PSMA concentrations are highest, clinicians can pinpoint areas of active cancer — including small deposits that conventional imaging may miss. At The Focal Therapy Clinic, this information is critical for confirming whether cancer remains localised before recommending focal therapy.
Why Is PSMA Important for Finding Prostate Cancer?
PSMA enables detection of prostate cancer at far earlier stages than conventional imaging. Because the PSMA PET tracer binds specifically to prostate cancer cells, it can identify small deposits of disease that CT scans, bone scans, and standard PET scans would miss — particularly when PSA levels are low.
Published research demonstrates that PSMA PET scans can detect cancer recurrence at PSA levels as low as 0.2 ng/mL (Fendler et al., JAMA Oncol, 2019). This early detection capability is especially valuable for men experiencing early symptoms of recurrence, or those with a rising PSA after previous treatment. At The Focal Therapy Clinic, early and accurate detection supports more treatment options — including focal therapies that preserve quality of life.
How Does a PSMA PET Scan Work?
A PSMA PET scan is a straightforward outpatient procedure that takes approximately 2–3 hours from arrival to completion. You receive a small injection of a radioactive tracer that binds to PSMA on prostate cancer cells, followed by a whole-body scan that creates detailed images showing exactly where cancer is — and where it is not.
What to expect during the scan
A small injection of the PSMA tracer (typically Gallium-68 or Fluorine-18 labelled) is administered into a vein in your arm. The tracer circulates through your bloodstream for approximately 60 minutes, binding to any prostate cancer cells it encounters. During this time, you rest quietly to allow the tracer to distribute properly.
You then lie on a table that slides through the PET scanner for approximately 20–30 minutes while detailed images are captured. The whole appointment typically takes 2–3 hours from start to finish. The procedure is painless and well-tolerated by most patients.
Tips to prepare:
- Wear metal-free clothing like jogging trousers or a plain T-shirt.
- Avoid jewellery, belts, glasses, or watches on the day.
- Let your team know if you feel anxious or claustrophobic, medication can be provided.
How the tracer targets prostate cancer cells
The PSMA PET tracer consists of two components: a molecule that binds specifically to PSMA proteins on prostate cancer cells, and a small amount of radioactive material that the PET scanner detects. Once injected, the tracer circulates through your bloodstream and attaches to prostate cancer cells wherever they are in the body — including deposits too small for conventional imaging to identify.
The two most commonly used tracers are Gallium-68 PSMA-11 and Fluorine-18 DCFPyL, both validated in international guidelines (Fendler et al., EANM/SNMMI Procedure Guideline, 2017). After the scan, your body clears the tracer naturally through urine within 24 hours. The level of radioactivity is very low and poses no risk to you or your family.How it compares to CT, MRI, and bone scans
How does PSMA PET compare to CT, MRI, and bone scans?
PSMA PET scans are significantly more accurate than conventional imaging for detecting prostate cancer spread. The landmark proPSMA trial (Hofman et al., Lancet, 2020) demonstrated that PSMA PET-CT had 27% greater accuracy than conventional imaging (bone scan + CT) for staging high-risk prostate cancer, and changed management decisions in 28% of cases
| Feature | PSMA PET Scan | Bone Scan | CT Scan | MRI |
|---|---|---|---|---|
| Detects active cancer | Yes — targets cancer cells directly | Limited — shows bone changes only | Limited — shows structure only | Good for local prostate detail |
| Sensitivity at low PSA | High (from 0.2 ng/mL) | Low | Low | Moderate (local only) |
| Whole-body coverage | Yes | Bones only | Yes | Limited regions |
| Changes treatment plan | In 28% of cases | Rarely | Sometimes | Sometimes |
| Best used for | Staging, recurrence, treatment planning | Suspected bone metastases | Soft tissue anatomy | Local prostate imaging |
Source: Hofman et al., proPSMA trial (Lancet, 2020); Rowe et al., Mol Imaging Biol, 2016
When Is a PSMA PET Scan used?
A PSMA PET scan is most commonly recommended at three key points: initial staging of newly diagnosed prostate cancer, detecting recurrence when PSA rises after treatment, and planning or adjusting therapy. NICE guideline NG131 on prostate cancer recognises the growing role of advanced imaging in treatment decision-making.
How Does PSMA PET Help Stage New Prostate Cancer?
When prostate cancer is first diagnosed, confirming whether it remains confined to the prostate is critical for treatment planning. A PSMA PET scan is particularly valuable for men with high-risk features — typically a Gleason score of 7 or above, PSA above 10 ng/mL, or clinical stage T2c and above.
At The Focal Therapy Clinic, PSMA PET scanning is part of our diagnostic workup for men being assessed for focal therapy. The scan helps confirm cancer is truly localised before recommending treatments such as HIFU or NanoKnife IRE. If the scan identifies spread beyond the prostate, our consultants discuss alternative treatment pathways at multidisciplinary team review.
Can a PSMA PET Scan Detect Cancer Recurrence?
Yes — PSMA PET scans can detect recurrent prostate cancer at PSA levels as low as 0.2 ng/mL, far earlier than conventional bone scans or CT imaging. A meta-analysis of 68Ga-PSMA-11 PET studies reported detection rates of 33% at PSA below 0.2 ng/mL, rising to 45% at PSA 0.2–0.5 ng/mL and 59% at PSA 0.5–1.0 ng/mL (Hope et al., J Nucl Med, 2019).
This early detection is clinically significant because it identifies whether cancer has returned locally or spread to distant sites — directly influencing whether salvage focal therapy, radiotherapy, or systemic treatment is most appropriate. At The Focal Therapy Clinic, PSMA PET results are reviewed at our multidisciplinary team meeting to determine the most suitable next step for each patient.
How Does PSMA PET Guide Treatment Planning?
PSMA PET scan results directly inform which treatments are most appropriate. When the scan confirms cancer is localised to a small area within the prostate, NICE-approved focal therapies such as HIFU (NICE IPG424) or NanoKnife IRE (NICE IPG768) may be suitable. If the scan shows cancer has spread beyond the prostate, other treatments such as radiotherapy or systemic therapy may be more appropriate.
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What Are the Benefits and Limitations of PSMA PET Scans?
PSMA PET scanning offers significantly greater accuracy than conventional imaging for prostate cancer, but — like all diagnostic tests — it has limitations. Understanding both helps you and your clinical team make fully informed treatment decisions.
How Accurate Are PSMA PET Scans?
PSMA PET scans are more sensitive and specific than conventional bone scans and CT for detecting prostate cancer spread. The landmark proPSMA trial (Hofman et al., Lancet, 2020) — a randomised study of 302 men with high-risk prostate cancer — demonstrated 27% greater accuracy for PSMA PET-CT compared with conventional imaging.
Crucially, PSMA PET results changed treatment plans in 28% of cases in the proPSMA trial. This means more than one in four men received a different — and more appropriate — treatment recommendation because of the scan. This precision is particularly important when assessing your individual prostate cancer risk and whether focal therapy is an option.
How Much Does a PSMA PET Scan Cost?
PSMA PET scans are increasingly available across the UK. Some NHS hospitals now offer them, though waiting times can be lengthy. Privately, PSMA PET scans are available through The Focal Therapy Clinic as part of our advanced diagnostic pathway for men being assessed for prostate cancer screening or focal therapy suitability.
Many private health insurance plans now cover PSMA PET scans, particularly for men with high-risk disease or biochemical recurrence. If you are self-paying, our patient coordinator can discuss costs and payment options. One of our consultant urological surgeons can advise whether a PSMA PET scan is clinically indicated for your situation.
Not suitable for all patients
PSMA PET scans are highly accurate but not infallible. A small proportion of prostate cancers — particularly some low-grade or neuroendocrine variants — produce little PSMA and may not be detected (false negatives). Conversely, some benign conditions can show PSMA uptake, occasionally producing false positive results. Your clinical team will interpret results alongside your full clinical picture.
Possible side effects (uncommon and generally mild):
- Injection site discomfort — minor soreness or swelling where the tracer was administered
- Mild allergic reaction — occasional itching or hives, typically self-resolving
- Transient symptoms — rare nausea or tiredness that passes within hours
Is a PSMA PET Scan Right for You?
A PSMA PET scan may be appropriate if you have been newly diagnosed with intermediate- or high-risk prostate cancer, if your PSA is rising after previous treatment, or if your clinical team needs to determine whether cancer remains localised before recommending focal therapy. Not every patient requires one — your consultant will advise based on your individual circumstances.
What Should You Ask Your Doctor About PSMA PET?
A PSMA PET scan is most likely to benefit you if your Gleason score is 7 or above, your PSA is rising, or you are being considered for focal therapy. Discussing the scan with your clinical team ensures it is performed at the right time and that results directly inform your treatment plan.
“Not every patient is suitable for focal therapy, and we’re transparent about that. We assess every referral carefully with mpMRI and targeted biopsy before recommending treatment.”
At The Focal Therapy Clinic, PSMA PET scans are part of our comprehensive diagnostic assessment. Every case is reviewed by our multidisciplinary team — including consultant urological surgeons with collective experience of over 2,000 focal therapy procedures across seven UK locations — to determine the most appropriate treatment pathway.
Questions to raise with your doctor:
- Will the scan change my treatment? — ask whether results would alter the recommended approach
- Is the timing right? — PSMA PET is most informative when PSA and clinical stage suggest potential spread
- What happens next? — understand which treatment options become available depending on results
- Is it covered by insurance? — many private plans now cover PSMA PET for high-risk or recurrent disease; for self-pay options, see our fees page
What Should You Do Next?
A PSMA PET scan can provide the detailed information needed to make confident, informed decisions about your prostate cancer treatment. Whether you are newly diagnosed, concerned about recurrence, or exploring whether focal therapy is right for you, this advanced imaging can help clarify your options.
At The Focal Therapy Clinic, our consultant urological surgeons use PSMA PET scanning alongside mpMRI and targeted biopsy to build a complete picture of each patient’s cancer. With over 2,000 focal therapy procedures performed across seven UK locations, our team has the experience to interpret results and recommend the most appropriate treatment pathway — whether that is HIFU, NanoKnife IRE, or an alternative approach.
To discuss whether a PSMA PET scan is right for your situation, book a consultation with one of our specialists.
FAQs
What is a PSMA PET scan for prostate cancer?
A PSMA PET scan is a specialised imaging test that uses a radioactive tracer to detect prostate cancer cells throughout the body. The tracer binds to prostate-specific membrane antigen (PSMA), a protein overexpressed on prostate cancer cells. This allows clinicians to see exactly where cancer is present and plan treatment accordingly. At The Focal Therapy Clinic, PSMA PET scanning is part of our diagnostic workup for men being assessed for focal therapy.
At what PSA level should a PSMA scan be done?
PSMA PET scans can detect cancer recurrence at PSA levels as low as 0.2–0.3 ng/mL (Fendler et al., JAMA Oncol, 2019), though detection rates improve with higher PSA levels. Your consultant urological surgeon will advise whether the timing is right based on your PSA trend, Gleason score, and treatment history.
How accurate is a PSMA test for prostate cancer?
PSMA PET scans are significantly more accurate than conventional imaging for detecting prostate cancer. The proPSMA trial (Hofman et al., Lancet, 2020) demonstrated 27% greater accuracy compared with standard bone scan and CT. However, like all diagnostic tests, PSMA PET can occasionally miss tumours with low PSMA expression (false negatives) or flag benign conditions (false positives).
What is the difference between a PET scan and a PSMA PET scan?
A standard PET scan uses a general tracer (FDG) that highlights areas of high metabolic activity throughout the body — including non-cancerous inflammation. A PSMA PET scan uses a tracer that specifically targets prostate cancer cells via the PSMA protein, making it far more specific and accurate for prostate cancer detection, staging, and monitoring.
References
Wright GL Jr, et al. Expression of prostate-specific membrane antigen in normal, benign, and malignant prostate tissues. Urol Oncol. 1995;1(1):18-28.
Perera M, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer. Eur Urol. 2020;77(4):403-417.
Fendler WP, et al. ⁶⁸Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging. Eur J Nucl Med Mol Imaging. 2017;44(6):1014-1024.
Hofman MS, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer (proPSMA). Lancet. 2020;395(10231):1208-1216.
Tilki D, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Part II-2024 Update: Treatment of Relapsing and Metastatic Prostate Cancer. Eur Urol. 2024;86(2):164-182.
Fendler WP, et al. Assessment of ⁶⁸Ga-PSMA-11 PET Accuracy in Localizing Recurrent Prostate Cancer. JAMA Oncol. 2019;5(6):856-863.
Hope TA, et al. Metaanalysis of ⁶⁸Ga-PSMA-11 PET Accuracy for Prostate Cancer Detection. J Nucl Med. 2019;60(6):786-793.
Rowe SP, et al. PSMA-Based PET/CT Is Superior to Conventional Imaging for Lesion Detection in Metastatic Prostate Cancer. Mol Imaging Biol. 2016;18(3):411-419.
This information is for educational purposes and should not replace professional medical advice. Individual results may vary, and all treatment decisions should be made in consultation with qualified healthcare professionals who can assess your specific circumstances.
