Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Practice changing for prostate cancer: a vision of the future

2018 has been an exciting year for imaging in urology, especially in the field of prostate cancer. In this context, multiparametric MRI and molecular imaging targeting prostate-specific membrane antigen provide practice-changing developments for detection and diagnostic work-up.

Key advances

  • Targeting biopsies in patients with abnormal findings on multiparamentric MRI (mpMRI) is superior to standard ultrasonography-guided biopsy in detecting clinically significant prostate cancer at initial evaluation1.

  • A minority of patients with negative mpMRI develop clinically significant prostate cancer at 4 years. Increasing PSA levels and higher PSA density predict increased likelihood of disease development3.

  • In biochemically recurrent prostate cancer, detection rates by 68Ga-PSMA-PET are ~55% and ~70% for patients with PSA values between 0.2 and 0.5 ng/ml and between 0.5 and 1.0 ng/ml, respectively5.

  • Results from 68Ga-PSMA-PET change management in approximately half of patients with biochemically recurrent prostate cancer6.

  • Novel fluorinated PSMA ligands might replace 68Ga-based PSMA ligands for PET staging of prostate cancer owing to reduced urinary excretion and advantageous pelvic imaging, easier handling and increased availability8.

This is a preview of subscription content

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: 68Ga-PSMA-PET–CT of a 74-year-old patient with recurrent prostate cancer (initial Gleason score 7) after radical prostatectomy and local salvage radiotherapy with rising serum PSA value (1.76 ng/ml at the time of assessment).


  1. 1.

    Kasivisvanathan, V. et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N. Engl. J. Med. 378, 1767–1777 (2018).

    Article  Google Scholar 

  2. 2.

    Ahmed, H. U. et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389, 815–822 (2017).

    Article  Google Scholar 

  3. 3.

    Panebianco, V. et al. Negative multiparametric magnetic resonance imaging for prostate cancer: what’s next? Eur. Urol. 74, 48–54 (2018).

    Article  Google Scholar 

  4. 4.

    Maurer, T. et al. Current use of PSMA-PET in prostate cancer management. Nat. Rev. Urol. 13, 226–235 (2016).

    CAS  Article  Google Scholar 

  5. 5.

    Rauscher, I. et al. Efficacy, predictive factors, and prediction nomograms for 68Ga-labeled prostate-specific membrane antigen-ligand positron-emission tomography/computed tomography in early biochemical recurrent prostate cancer after radical prostatectomy. Eur. Urol. 73, 656–661(2018).

    Article  Google Scholar 

  6. 6.

    Han, S. et al. Impact of 68Ga-PSMA PET on the management of patients with prostate cancer: a systematic review and meta-analysis. Eur. Urol. 74, 179–190 (2018).

    CAS  Article  Google Scholar 

  7. 7.

    Maurer, T. et al. 99mTechnetium-based prostate-specific membrane antigen-radioguided surgery in recurrent prostate cancer. Eur. Urol. (2018).

    Article  PubMed  Google Scholar 

  8. 8.

    Giesel, F. L. et al. Detection efficacy of [18F]PSMA-1007 PET/CT in 251 patients with biochemical recurrence after radical prostatectomy. J. Nucl. Med. (2018).

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Tobias Maurer.

Ethics declarations

Competing interests

All authors declare no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Maurer, T., Eiber, M. Practice changing for prostate cancer: a vision of the future. Nat Rev Urol 16, 71–72 (2019).

Download citation

Further reading


Quick links