Joint survey by AIMN, AIOM, AIRO, SIU, SIUrO, and Meet-URO about the use of PSMA PET imaging in prostate cancer in Italy: technical aspects and primary staging setting

Background: Prostate-specific membrane antigen PET/CT (PSMA PET/CT) has become a cornerstone in the imaging of prostate cancer (PCa), supported by growing evidence and international guideline endorsements. However, real-world adoption and clinical integration of PSMA PET/CT in Italy remain poorly characterised. Methods: A multidisciplinary national cross-sectional survey was developed and distributed between November 4–29, 2024, with endorsement from six major Italian scientific societies. The survey included 93 questions addressing availability, technical aspects, clinical use across disease phases, and professional practices. Separate sections were tailored to clinicians and nuclear medicine physicians. Results: A total of 238 validated responses were analysed (169 clinicians, 69 nuclear medicine physicians). Nuclear medicine respondents were affiliated mainly with high-volume centres, while clinicians reported greater variability in institutional access. PSMA PET/CT was perceived as insufficiently available by 58% of clinicians at the institutional level, with 36.1% stating that waiting times led to changes in imaging strategy. [68Ga]Ga-PSMA-11 was the preferred tracer among clinicians (57.4%), while nuclear medicine physicians expressed more balanced preferences driven by logistics. Divergent views also emerged regarding the clinical relevance of biodistribution differences. For primary staging, PSMA PET/CT was used by 50% of clinicians for high-risk patients and by 20% for intermediate-risk patients, whereas 87% of nuclear medicine physicians identified PSMA PET/CT as the optimal imaging modality for intermediate-to-high-risk PCa. In cases of discordant imaging findings, multidisciplinary discussion was the preferred strategy for resolution. Conclusion: Access to, usage of, and perceptions about PSMA PET/CT differ between clinicians and nuclear medicine physicians, highlighting the need for improved availability and enhanced interdisciplinary coordination.