Active surveillance is the preferred treatment for men with low-risk and select men with favourable intermediate risk prostate cancer. A recent advance in prostate cancer staging has been the PSMA PET Scan, which uses a tracer that binds strongly a highly expressed cellular biomarker for prostate cancer. Recent evidence has demonstrated that PSMA PET may also be a useful tool for risk stratifying prostate cancer, with the SUVMax of the scan correlated with higher grades prostate cancer. This has attracted interest in the potential use of PSMA PET in identifying men with higher risk prostate cancer that may be unsuitable for active surveillance, due to occult high-grade disease.

This review exams the current evidence within the English language literature, assessing the current evidence base for the use of PSMA PET in risk stratification, diagnosis and active surveillance of prostate cancer. It exams published data on the above, as well as key trials, guidelines and ongoing research into the use of PSMA PET in active surveillance

Our review identified 3 published studies that have specifically assessed the utility of PSMA PET in active surveillance, as well as two ongoing clinical trials actively recruiting. We also reviewed major oncology guideline statements, and assessed the growing evidence base that demonstrates that PSMA PET cand predict adverse pathological findings and higher percentage pattern 4 disease on final histology. This evidence suggests that patients with adverse pathological features may be unsuitable for active surveillance.

The PSMA PET scan has started to show promise in risk stratifying men with newly diagnosed prostate cancer, and identify adverse pathology. This may have implications for active surveillance, as it would allow for better detection of men that are unsuitable for surveillance due to occult high-grade disease.To date, there has only been one prospective trial, and two smaller retrospective studies which have assessed the use of PSMA PET in active surveillance. It remains a promising concept but has yet to accumulate enough high-grade evidence to support its routine clinical use. There are currently at least two ongoing prospective trials assessing for the utility of PSMA PET in active surveillance protocols. These trials, and other further research will determine whether there is clinical utility for incorporating PSMA PET into active surveillance protocols.