Prostate Cancer Imaging

Imaging scans may be used to help your doctor biopsy, diagnose, and stage prostate cancer. Imaging scans can also help determine if the cancer has spread throughout the body, where it may have spread, plan treatment, or find out if a treatment option is working.

MRI scan with two images of a prostate overlaid

Understanding prostate cancer imaging

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Conventional imaging

Conventional imaging options usually include:

  • Ultrasound – Can be used to look for suspicious areas in the prostate
  • Bone Scan – Shows prostate cancer that may have spread to bones
  • MRI Scan – Can help determine if a biopsy is needed, guide needles for a biopsy, and help determine the stage of prostate cancer
  • CT Scan – Can help detect prostate cancer in lymph nodes and, after a recurrence, can help determine organ involvement

Advanced imaging

All imaging tests have limitations. Some are better at detecting cancer in lymph nodes, some work best if the PSA levels are rising, and others may miss small areas of prostate cancer that have come back or spread. With the discovery of new imaging agents, these pictures of the inside of the body make it easier to see prostate cancer cells, even in small amounts, that have traveled outside the prostate to other places in the body. These advances are improving how a patient’s prognosis, or outcome, is determined, if a treatment is working, and how treatment decisions are made. 

PET/CT scan

A PET/CT combines two imaging techniques – a PET scan and a CT scan – to get a better picture of the body. A PET scan shows physiologic changes in the body and a CT scan shows a detailed picture of your anatomy where those changes might be taking place. Together, they provide a more detailed picture of the extent and location of the prostate cancer. One advanced diagnostic imaging agent is currently approved by the FDA, and it targets the increase in amino acid transport that occurs in many prostate cancers, making it easier to spot prostate cancer in the imaging scans. Some of the traditional PET tracers tend to be less sensitive than the more advanced, newly available tracers.


A PSMA PET (positron emission tomography) scan is an imaging procedure used to help detect prostate cancer cells within the body. For this procedure, a radioactive agent is injected into the bloodstream prior to the PET scan. The agent then attaches to the PSMA protein on the prostate cancer cells. Once there, it glows in the PET images that are taken to indicate where prostate cancer cells that have traveled outside the prostate may be. This procedure allows prostate cancer cells to be found that may not have been picked up on traditional scans like CT scans and bone scans. A few PSMA PET imaging agents are now approved by the FDA for use in patients whose prostate cancer has recurred or spread. This video from the Cleveland Clinic explains in more detail how PSMA PET imaging in prostate cancer works. 

Watch this video for more information on PSMA PET imaging – registration is required. Dr. Neal Shore and Dr. Thomas Boike, along with Shelby Moneer, VP Patient Programs and Education at ZERO, discuss how advanced imaging like PSMA PET scans can be used to determine staging and localization, detect lesions in recurrence, monitor treatment, and stratify risk in metastatic disease.

In the video below, Shelby Moneer and Dr. Tomasz Beer discuss PSMA PET Imaging for Prostate Cancer and how it can provide more precise testing to better guide prostate cancer treatment decisions.

What is PSMA?

PSMA = Prostate-Specific Membrane Antigen

PSMA is a protein found on the surface of normal prostate cells, but it is found in higher amounts on prostate cancer cells. It is present in more than 80% of prostate cancer cells in men with prostate cancer. PSMA has been the subject of extensive and promising research over the last several decades. It is now used as a target for imaging to diagnose metastatic or recurrent prostate cancer, and it is also being explored as a target for medications that can treat prostate cancer. This dual purpose is why some refer to PSMA as a “theranostic” – a combination of the terms ‘therapeutics’ and ‘diagnostics’.