{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:07:05Z","timestamp":1792516025465,"version":"4.5.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>Multiparametric MRI (mpMRI) has transformed the diagnostic pathway for suspected prostate cancer by improving the detection of clinically significant prostate cancer (csPCa) and reducing unnecessary biopsies. However, its negative predictive value declines in higher-risk populations, and up to 30% of men with negative or indeterminate mpMRI (PI-RADS 1\u20133) may still harbour csPCa, particularly those with adverse clinical features. Variability in MRI quality, reader expertise, and reference standards further limits reproducibility outside expert centres. Prostate-specific membrane antigen (PSMA) PET-CT has emerged as a promising complementary modality. Beyond its role in staging and recurrence, prospective studies support its value in the pre-biopsy setting. Trials such as PRIMARY, PEDAL, and others demonstrate that PSMA PET\/CT can detect a substantial proportion of csPCa missed by mpMRI, with high sensitivity and negative predictive value. The development of structured reporting systems, notably the PRIMARY score, represents an important step towards standardisation and improved comparability across studies. Despite encouraging diagnostic performance, critical uncertainties remain. The biological significance of PSMA-positive, MRI-negative lesions is unclear, and higher detection rates may partly reflect intensified sampling rather than clinically meaningful disease. Cost-effectiveness, optimal patient selection, and the positive predictive value of PSMA-avid lesions in MRI-negative prostates require further prospective validation. This opinion piece reviews high-quality prospective evidence and argues that PSMA PET\/CT has the potential to refine risk stratification and reduce unnecessary biopsies in selected men with persistent suspicion of prostate cancer. Integration into diagnostic pathways should be guided by imaging performance and biological relevance, ensuring that the detected disease is clinically meaningful.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Can PSMA PET\/CT improve risk stratification and reduce missed clinically significant prostate cancer in men with negative or indeterminate mpMRI?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Prospective studies show PSMA PET\/CT complements mpMRI, achieving high sensitivity and negative predictive value while detecting a substantial proportion of significant cancers missed by MRI.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>PSMA PET\/CT may help safely avoid unnecessary biopsies and identify clinically significant disease in selected men after negative or equivocal MRI, but adoption requires standardised reporting, biological validation of PSMA-positive\/MRI-negative lesions, and careful evaluation of cost-effectiveness within routine clinical pathways.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12596-3","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:10:50Z","timestamp":1777522250000},"page":"7063-7072","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["PSMA PET: the answer to MRI-occult prostate cancer\u2026 or another mirage?"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3867-6829","authenticated-orcid":false,"given":"Thomas","family":"Wagner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Emberton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iztok","family":"Caglic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitris","family":"Priftakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giganti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veeru","family":"Kasivisvanathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shonit","family":"Punwani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"12596_CR1","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1038\/s41585-019-0212-4","volume":"17","author":"A, Giganti F, Rosenkrantz AB Stabile","year":"2019","unstructured":"Stabile A, Giganti F, Rosenkrantz AB et al (2019) Multiparametric MRI for prostate cancer diagnosis: current status and future directions. 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He has received speaker fees from Bayer and Siemens. He is a member of the scientific editorial board of\n                      European Radiology\n                      and, as such, did not participate in the selection or review processes for this article. T.W. reports consulting and speaker fees from Telix outside of the submitted work. S.P. reports consulting fees from NVISION IMAGING, Gold Standard Phantoms and Quibim outside of the submitted work. M.E. has research support from the National Institute of Health Research, University College London Hospital, and the UCL Biomedical Research Centre; and a consultant\/advisor role for Sonacare, Angiodynamics, Profound Medical, Insight Medbotics, NINA Medical, Early Health, and Albemarle Biosciences.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No complex statistical methods were necessary for this paper.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Patient consent for publication was not required, as the only presented image is appropriately anonymised.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was not required because this article is a narrative review.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"None.","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}