How to Decode Your PSMA-PET Scan and Track Prostate Cancer
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How to Decode Your PSMA-PET Scan and Track Your Metastatic Prostate Cancer Treatment Progress

How to Decode Your PSMA-PET Scan and Track Your Metastatic Prostate Cancer Treatment Progress
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Published on September 23, 2026
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Reviewing your results from a PSMA-PET scan can feel like you’re reading a foreign language, especially when you see unfamiliar terms like “SUVMax” and “radiotracer uptake.” But you don’t need a medical degree to follow along with this diagnostic test for metastatic prostate cancer (cancer that’s spread beyond the prostate).

Once you understand how the scan works, what it measures, and how your care team reads it, you'll feel a bit more empowered, and an otherwise intimidating report will be a useful one.

How PSMA-PET Scans Differ From Standard CT and Bone Scans

PSMA stands for “prostate-specific membrane antigen,” a type of protein that’s found in abundance on the surface of most prostate cancer cells. A PSMA-PET scan detects tumors using a radiotracer, a radioactive material that binds specifically to PSMA anywhere in the body before releasing a tiny amount of radiation that “lights up” on positron emission tomography (PET) scans.

A PSMA-PET scan works very differently from traditional imaging methods like standard computed tomography (CT) and bone scans.

“Conventional imaging like bone scans and particularly CT scans are highly dependent on the size of the lesions that are detected,” says Amir Iravani, MD, a nuclear medicine physician with UCLA. These techniques show anatomical changes, such as a bone that has changed shape or a lymph node that is growing, potentially indicating cancer.

“But we know that cancers obviously grow on a spectrum,” Dr. Iravani says. “There are smaller lymph nodes that could be harboring cancer cells and not reaching that particular size [to be considered a tumor] on anatomical imaging. And sometimes bone lesions don’t cause any changes on CT.”

A PSMA-PET scan can detect small clusters of prostate cancer cells before they’ve caused any obvious structural changes.

Research suggests that PSMA PET is 27 percent more accurate than the traditional combination of CT and bone scans for detecting metastatic prostate cancer.

 Small studies even suggest PSMA-PET can detect recurrent or metastatic disease earlier than older imaging methods.

Plain-Language Breakdown of SUV Metrics

If a PSMA-PET scan finds your prostate cancer is “PSMA-positive,” it means that you have at least one metastatic tumor with high levels of PSMA, making you eligible for a type of treatment called PSMA therapy, or PSMA-targeted radioligand therapy.

 Terms like SUV, SUVmax, and SUVmin in your report provide more details about the cancer.

What SUV Means

In the report, you may see the term “radiotracer uptake,” referring to areas in the body where the tracer has accumulated because it has attached to the PSMA on cells.

 These areas will show up as bright spots of varying degrees in the images from the PET scan, and a measurement of this brightness (how much accumulation there is) is called a standard uptake value, or SUV.

“The SUV values are quantitative metrics,” Iravani says, “a kind of number of how much [radiation] occurred in a specific volume.”

Importantly, bright spots or uptake don’t necessarily mean cancer. Various organs in the body, including the small intestines, liver, kidneys, and salivary glands, also express PSMA that the radiotracer can bind to.

 The liver is typically used as a reference organ as it takes up a highly predictable amount of radiotracer. Areas in the scan that are brighter or have higher SUV values than the liver may indicate metastatic tumors.

SUVmax vs. SUVmean

SUVmax refers to the highest SUV value of all the bright spots within a specific region of interest on your scan, says Daniel Sentana, MD, a medical oncologist with the Dana-Farber Cancer Institute in Boston, noting that the brightest spot with the most radiotracer uptake “tends to suggest that's a place where there are more cancer cells.” SUVmean, on the other hand, is a measurement of the average amount of tracer uptake across that region, he says.

Providers use both SUVmax and SUVmean to help guide a treatment plan and make an educated guess on how responsive your cancer will be to PSMA therapy.

 They also consider other factors like tumor volume (how many lesions there are), because SUVmax and SUVmean aren’t absolute markers of how well your cancer is going to respond to PSMA therapy, Dr. Sentana says. “We still cannot make complete recommendations about whether you should or you should not get it just because [your scan] does not have a certain amount of SUVmean or SUVmax.”

If You Have a High SUV Number

A high SUV number means that your tumor cells express a lot PSMA or that you have a lot of cancer cells expressing PSMA, which the scan is built to find.

It also means you’re likely eligible for PSMA therapy, which works using a drug called lutetium Lu-177 vipivotide tetraxetan (Pluvicto) that attaches to PSMA and then releases cancer killing radiation directly to tumor cells.

Iravani suggests not focusing too much on SUV numbers because those metrics are more relevant to the experts who interpret the scans. For patients, the location, number, and size of the metastatic lesions are “more important than SUV, per se,” he says.

Evaluating Treatment Response vs. Progression

Currently, lutetium Lu-177 vipivotide tetraxetan is only approved for prostate cancer when used in combination with hormone therapy.

 Once this treatment begins, subsequent PSMA-PET scans may show decreasing SUV numbers, potentially indicating the treatment is working.

Generally, however, providers don’t use PSMA-PET to evaluate your response to the treatment or the progression of your cancer for a couple of reasons, says Scott Tagawa, MD, a professor of medicine and urology at Weill Cornell Medicine in New York City. “There’s no FDA-approval that says sequential PETs are okay,” he says, meaning your insurance will likely not cover PSMA-PET beyond the first diagnostic scan. Additionally, up to 10 percent of prostate cancer cells do not express PSMA, and these tumors will be unaffected by PSMA therapy and missed by PSMA-PET scans, he says.

Other scans, such as CT and bone scans, are usually used to track cancer progression. “Those have been the long-term benchmark way of telling if a cancer is growing or is being treated,” Sentana says, adding that how you’re feeling after treatment and the levels of other biomarkers like prostate-specific antigen (PSA) are also important. “You have to take a couple of these pieces into consideration before truly saying, ‘Okay, this treatment's not helping you,’” Sentana says.

Questions to Ask Your Doctor

Some questions you may want to ask your provider to better understand your diagnosis and PSMA PET results include:

  • How could the scan results affect my treatment plan?
  • What do my SUV numbers mean for me?
  • Do I need to get additional diagnostic tests like an MRI or biopsy?
  • What are some signs I might benefit from a post-treatment PSMA PET scan?
  • Will my insurance cover additional scans?
  • What if my scan doesn’t show anything?
Your care team will also be able explain what to expect during the exam and answer any other questions you may have.

Resources We Trust

EDITORIAL SOURCES
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Resources
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  4. Hofman MS et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. The Lancet. April 11, 2020.
  5. Kranzbühler B et al. Detection Rate and Localization of Prostate Cancer Recurrence Using 68Ga-PSMA-11 PET/MRI in Patients with Low PSA Values ≤ 0.5 ng/mL. The Journal of Nuclear Medicine. February 1, 2020.
  6. Pluvicto. San Antonio Cancer Center.
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  9. Scanlan K et al. PSMA and Salivary Glands - A Primer for Residents and Nuclear Medicine Physicians. The Journal of Nuclear Medicine. June 1, 2025.
  10. Gregory SY. Expanding Cancer Treatment with Theranostics. Mayo Clinic. January 21, 2026.
  11. Stallard J. FDA Expands Approval of Pluvicto® for Metastatic Prostate Cancer: Targets a Protein Called PSMA. Memorial Sloan Kettering Cancer Center. August 14, 2026.
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  13. Why You Might Need a PSMA PET Scan for Advanced Prostate Cancer. Cleveland Clinic. August 4, 2026.
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