Prostate Anatomy: What Is Relevant for a Nuclear Medicine Practitioner

PSMA PET has become central to prostate cancer imaging as advanced disease incidence rises and prostate-specific membrane antigen (PSMA)-targeted theranostics expand clinical use, yet accurate interpretation requires an understanding of prostate anatomy and physiology that extends beyond rote imaging patterns. Here we review prostate zonal anatomy, multimodality imaging features from ultrasound, multiparametric MRI, and PSMA PET/CT, and the underlying biology of PSMA expression, and androgen receptor signaling, and tumor dedifferentiation. We highlight physiologic and pathologic variations in PSMA uptake, common diagnostic pitfalls, and characteristic imaging changes after androgen-deprivation therapy, radiation, and prostatectomy. By relating anatomy, molecular physiology, and treatment effects to PSMA PET findings, this article provides nuclear medicine practitioners with a practical foundation to improve diagnostic accuracy and optimize patient selection for PSMA-based imaging and therapy.