Review – Prostate Cancer The Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging in Primary and Recurrent Prostate Cancer: A Systematic Review of the Literature Celeste Manfredi a , Esau ´ Ferna ´ndez-Pascual b,c , Davide Arcaniolo a , Mark Emberton d , Rafael Sanchez-Salas e , Carlos Artigas Guix f , Fernando Bianco g , Paul Cathcart h , Declan G. Murphy i , Felipe Coun ˜ago j , Claudio Martı´nez-Ballesteros c,k , Paolo Verze l , Juan Ignacio Martı´nez-Salamanca c,k, * a Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy; b Department of Urology, Hospital Universitario La Paz, Madrid, Spain; c LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain; d Division of Surgery and Interventional Science, University College London, London, UK; e Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; f Nuclear Medicine Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Bruxelles, Belgium; g Urological Research Network, Nova University, Miami, FL, USA; h Department of Urology, Guy’s and St Thomas NHS Foundation Trust, London, UK; i Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; j Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; k Department of Urology, Hospital Universitario Puerta De Hierro- Majadahonda, Madrid, Spain; l Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy E U R O P E A N U R O L O G Y F O C U S X X X ( 2 0 2 1 ) X X X – X X X ava ilable at www.sciencedirect.com journa l homepage: www.europea nurology.com/eufocus Article info Article history: Accepted August 31, 2021 Associate Editor: Christian Gratzke Keywords: Imaging Positron emission tomography/ magnetic resonance imaging Prostate cancer Prostate-specific membrane antigen Abstract Context: Prostate-specific membrane antigen (PSMA) positron emission tomography/ magnetic resonance imaging (PET/MRI) is a novel imaging technique with several potential applications in the prostate cancer (PCa) setting. Objective: To perform a systematic review of the current evidence regarding the diagnostic performance of PSMA PET/MRI in patients with primary and recurrent PCa. Evidence acquisition: A comprehensive bibliographic search on the MEDLINE and Cochrane Library databases was performed in October 2020. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies were deemed eligible if they assessed patients with primary or recurrent PCa (P) undergoing PSMA PET/MRI (I) with or without comparison with other imaging techniques (C) in order to evaluate its diagnostic performance (O). Retrospective and prospective primary clinical studies were included. Results of previ- ous meta-analyses were reported. Evidence synthesis: A total of 23 original articles and three meta-analyses were included. Limited evidence on PSMA PET/MRI is available, especially in the setting of partial gland ablation. PET/MRI can be an effective imaging modality for detecting primary PCa, showing higher accuracy than multiparametric MRI alone. It provides accurate local staging of primary PCa; however, there are contradictory results in this context when its performance is compared with other imaging techniques. PET/MRI also * Corresponding author. Department of Urology, Hospital Universitario Puerta De Hierro-Majada- honda and LYX Institute of Urology, Universidad Francisco de Vitoria, Ctra. Pozuelo-Majadahonda Km 1,800, 28223 Pozuelo de Alarcón, Madrid, Spain. Tel.: +34 91 191 61 97; Fax: +34 91 191 68 06. E-mail address: jims09@me.com (J.I. Martínez-Salamanca). EUF-1185; No. of Pages 16 Please cite this article in press as: Manfredi C, et al. The Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging in Primary and Recurrent Prostate Cancer: A Systematic Review of the Literature. Eur Urol Focus (2021), https://doi.org/10.1016/j.euf.2021.08.013 https://doi.org/10.1016/j.euf.2021.08.013 2405-4569/© 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.