PSMA-PET in clinical practice: Juan Gómez Rivas, MD, on barriers to access

In this video, Juan Gómez Rivas, MD, FEBU, PhD, discusses the barriers limiting access to prostate-specific membrane antigen (PSMA)-PET in clinical practice and the potential implications for prostate cancer staging and treatment planning. Gómez Rivas is a urologist at Clinico San Carlos Hospital in Madrid, Spain.

Access to PSMA-PET remains heterogeneous across countries and health care systems, as well as within certain regions. Gómez Rivas notes that reimbursement policies are a major factor, while regulatory requirements, limited radiotracer availability or PET scan capacity, and shortages in nuclear medicine expertise can also restrict access. He explained that even when the necessary technology is available, inefficient referral pathways and complex approval processes may delay imaging.

“Access is not simply a question about if a country has enough PET scans or enough people who can interpret these scans,” Gómez Rivas says. “It is the entire pathway: the tracer production, the infrastructure, the reimbursement, the referral, the expertise, the reporting, [and] the waiting times.”

Gómez Rivas also noted that limited or delayed access may have clinical implications since PSMA-PET findings can inform treatment selection across different stages of prostate cancer. In newly diagnosed disease, unavailable or delayed PSMA-PET may result in less accurate staging and make it more difficult to identify nodal or distant metastases when determining whether local therapy, multimodal treatment, or systemic therapy is appropriate. In biochemical recurrence, timely imaging can help localize disease and inform decisions regarding salvage treatment or metastasis-directed therapy. When PSMA-PET is unavailable, clinicians may instead need to rely on imaging modalities with lower sensitivity for certain sites of recurrent or metastatic disease.

Gómez Rivas also highlights the potential equity implications of differences in access, noting that patients with otherwise similar disease characteristics may undergo different diagnostic and treatment pathways based on where they receive care. However, he cautioned that evidence directly linking disparities in PSMA-PET access with long-term oncologic outcomes remains limited.

He concluded, “What we do know is that access can affect staging, disease location, treatment planning, and therefore delivery of evidence[-based] medicine, which is the usage of PSMA-PET in prostate cancer.”

REFERENCE

1. Peyrottes A, Turpin L, Fernández Hernández L, Gómez Rivas J, Rouprêt M. PSMA PET in prostate cancer: Clinical value, access challenges, and priorities for implementation. Eur Urol Oncol. 2026:S2588-9311(26)00197-5. doi:10.1016/j.euo.2026.07.007