Fluorine- or gallium- prostate-specific membrane antigen positron emission tomography radiotracers

Topic Status Complete

Fluorine- or gallium- prostate-specific membrane antigen (PSMA) positron emission tomography (PET) radiotracers in the investigation of recurrent prostate cancer.

Outcome of the appraisal


The adoption of 68Ga prostate-specific membrane antigen (PSMA) positron emission tomography (PET) for the diagnosis of recurrent prostate cancer is partially supported by the evidence. The use of 68Ga PSMA PET provides a high degree of diagnostic accuracy on which to base management decisions as compared with conventional tracers. However, evidence comparing 68Ga PSMA PET to other tracers is limited, and estimating the cost of using 68Ga PSMA PET for the investigation of possible recurrent prostate cancer is complex and uncertain. Therefore, 68Ga PSMA PET is recommended if the service can be delivered at no greater cost than current standard care.

The adoption of 18F PSMA PET for the diagnosis of recurrent prostate cancer is not supported by the evidence.

Why was this topic appraised?


Many men who have been treated for prostate cancer may develop a recurrence of the cancer at a variable time after their initial treatment. This may be detected as a result of new symptoms or after biochemical surveillance. When this happens, early detection and precise localisation of the site of recurrence is critical so that appropriate further treatment decisions can be made. PSMA PET tracers have been developed to improve the accuracy of the diagnosis of recurrent prostate cancer.

Plain language summary


HTW assessed fluorine or gallium PSMA PET to help decide whether it should be made available to NHS Wales to diagnose possible recurrent prostate cancer.

When men suffer a recurrence of prostate cancer, it’s important to find exactly where the cancer has reoccurred as accurately as possible. One test that can be used for this is a PET scan, during which a tracer is used that helps to distinguish between cancerous and normal tissue.

The evidence suggests that gallium PSMA PET tracers are more accurate than choline-based PET tracers in identifying recurrent prostate cancer and this is likely to lead to better decision-making about how the cancer is treated. It’s difficult to estimate the total cost because there are many factors to consider and a lack of published research.

Based on the evidence available, HTW’s Guidance supports use of gallium PSMA PET only if it’s not more expensive than current standard care. However, there is not enough evidence to support the use of fluorine PSMA PET.

Topic Exploration Report

TER004 (06.2018)

View PDF

Evidence Appraisal Review

EAR005 (01.2019)

View PDF


GUI005 (01.2019)

View PDF

Access our guidance

Our advice documents are free to download, but we would be grateful if you could help us improve our services by telling us why you are looking at our advice and how you intend to use it.
  • We may like to contact you by email to find out more about how you used the documents.

  • This field is for validation purposes and should be left unchanged.