The Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA PET) scan is an advanced medical imaging technique used primarily for prostate cancer detection. This scan utilizes a specialized radioactive tracer that targets the PSMA protein, which is often found in high concentrations on prostate cancer cells. Once injected, the tracer accumulates in these areas, which a PET scanner then detects. The scan is valued for its ability to pinpoint small cancer lesions missed by conventional imaging methods. It is used to determine the extent of the cancer during initial staging or to locate recurrence when blood tests show a rising Prostate-Specific Antigen (PSA) level after initial treatment.
Locating Authorized Facilities
The availability of a PSMA PET scan is directly tied to the facility’s authorization to handle the specific radioactive tracers approved by the U.S. Food and Drug Administration (FDA). Two main types of tracers are used: Gallium 68 PSMA-11 and F-18 DCFPyL (known commercially as PYLARIFY). Academic medical centers and major specialized cancer hospitals were typically the first to offer this technology, particularly the Gallium 68-based tracers, which initially required on-site production.
Availability has become more widespread with the approval of F-18 DCFPyL, as the F-18 isotope has a longer half-life, allowing the tracer to be shipped to more distant locations. Many large outpatient radiology and imaging centers now offer the PSMA PET scan. Geographic access is a factor, as urban centers and regions with high-volume cancer programs are more likely to have the necessary equipment and licensing than rural areas. Facilities must be licensed to receive and administer these short-lived radiopharmaceuticals, and patients should confirm which FDA-approved tracer their local center uses.
Some patients may also access the scan through participation in clinical trials, which often test newer PSMA-targeting compounds. However, for a standard diagnostic scan, the procedure must be performed at a facility that has adopted one of the commercially available FDA-approved tracers. Checking a facility’s nuclear medicine department or the manufacturer’s website for a list of authorized providers can help locate the nearest available site.
Navigating Referrals and Insurance Coverage
Obtaining a PSMA PET scan requires a specific referral from a treating physician, typically an oncologist or urologist, who determines medical necessity based on established guidelines. This referral is the first administrative step toward scheduling the procedure. The facility must often seek insurance pre-authorization before the scan can be scheduled, which can take several days or weeks.
While Medicare and many major private insurers have begun to cover the PSMA PET scan, especially after the Centers for Medicare & Medicaid Services provided dedicated billing codes, coverage is not guaranteed for every patient or indication. The facility’s billing department will verify coverage, and the patient should proactively confirm their specific policy details for the radiotracer and the imaging service. Patients should inquire about potential out-of-pocket costs, including co-pays and deductibles, as the scan and the specialized tracer are expensive.
If a patient’s insurance does not cover the procedure, the facility may issue an Advance Beneficiary Notice (ABN), informing the patient that they will be personally responsible for the cost if they choose to proceed. The logistical challenge is also compounded by the tracer’s short half-life, which means the scan must be tightly coordinated with the tracer’s delivery, requiring a precise and non-negotiable appointment time.
Patient Preparation and Procedure Details
Preparation for a PSMA PET scan must be followed precisely to ensure the highest image quality. Patients are advised to fast for four to six hours before the scheduled appointment, consuming only plain water. Hydration is encouraged; patients are typically asked to drink extra water in the hours leading up to the scan to help minimize tracer accumulation in the bladder.
Patients should discuss all current medications with the facility beforehand, especially those for diabetes, though most medications can be taken as usual. Upon arrival, the procedure begins with an intravenous injection of the radioactive PSMA tracer into a vein in the arm. A waiting period of approximately one hour is necessary after the injection to allow the tracer to circulate and bind adequately to the PSMA proteins.
The patient then lies on a table that moves into the PET scanner, where they must remain still for the duration of the scan, which typically lasts between 20 to 40 minutes. The entire appointment, from check-in to completion, usually requires about two to three hours. Following the scan, patients can usually resume normal activities. They are often advised to drink plenty of fluids to help flush the small amount of remaining tracer from their system.