Currently national and international guidelines for imaging procedures for high-risk and advanced prostate cancer (PCa) include abdomino-pelvic cross sectional imaging, multiparametric prostate MRI, bone scintigraphy and in the case of therapy monitoring of mCRPC whole body cross-sectional imaging mainly by means of computed tomography. Positron emission tomography (PET) has became increasingly important in the work-up of prostate cancer. Recently, a ⁶⁸Gallium-labelled ligand of the prostate-specific membrane antigen (⁶⁸Ga-PSMA) has been introduced in PET-imaging of PCa with first promising results. Due to relatively exclusive expression of PSMA in prostatic tissue as well as increased expression in PCa ⁶⁸Ga-PSMA was reported to exhibit a favourable lesion to background ratio compared to presently used choline- or fluorodesoxyglucose-based PET examinations. Together with the novel development of combined PET/MR, the combination of excellent morphological detail, multiparametric functional information and molecular PET data might lead to a significant improvement in detection and staging of PCa and thus may help to optimize oncological treatment. Teaching and learning contents of the talk will include:

1. The molecular basis of prostate cancer imaging targeting the prostate-specific-membran antigen (PSMA), review of the various PSMA-tracers
2. The diagnostic performance and potential role of PSMA PET/CT and PET/MR for high-risk primary and advanced prostate cancer
3. Challenges using Ga-labelled PSMA-agents in PET/MR
4. Comparison of the workflow for integrated PET/MR vs. PET/CT
5. Outline of a potential approach for patients selection towards PET/MR vs. PET/CT