在前列腺癌（PCa）中，关于前列腺特异性膜抗原（PSMA）正电子发射断层成像（PET）和PSMA放射配体治疗的适应症、先进成像在计分卡决策中的整合、剂量学以及新治疗应用的发展仍存在疑问。本研究旨在批判性地审查分子混合成像和系统放射配体治疗的进展，达成关于PCa现状的多学科共识。通过系统的文献搜索，确定一个由28名PCa专家组成的医学或放射肿瘤学、泌尿外科、放射学、医学物理学和核医学领域的专家小组进行两轮Delphi法的调查。调查结果在一个共识会议中进行讨论和确定。共有48个陈述受到Likert一致性量表评分，其中6个作为排名选项评分。根据RAND一致性方法对一致性陈述进行分析，根据加权比分对排名陈述进行分析。经过两轮Delphi法调查，有42/48（87.5%）的陈述达成共识。专家小组建议使用PSMA PET为不利的中高风险患者分期，并用于疑似复发PCa的再分期。一致认为少转移病变应定义为高达五个转移灶，即使使用先进的成像工具也是如此。小组一致认为，[177Lu]Lu-PSMA不应仅在卡巴妥索进展后使用，而[223Ra]RaCl2在仅骨转移的去势抗性PCa中仍然是有效的治疗选择。关于多个主题仍存在不确定性，包括在[177Lu]Lu-PSMA治疗前，[18F]FDG和PSMA PET是否需要一致的检查结果。在PCa分子成像和治疗学领域的专家小组中存在高比例的一致性。尽管共识性陈述不能取代高可靠性证据，但可以帮助解释和传播卓越中心的最佳实践给更广泛的临床团队。 在处理前列腺癌（PCa）时存在一些情况，诊断和跟踪疾病发展和对治疗的反应的医生以及进行治疗的医生都不确定什么是最佳行动方案。例如，他们应该使用何种方法来获取癌症的成像，以及在癌症复发或扩散时应该采取什么措施。我们审查了已发表的研究并向成像和治疗PCa的专家小组提供了一份总结。我们还使用研究摘要编制了一个问卷，在问卷中我们请专家说明他们是否同意一系列陈述。我们利用这些结果为其他医疗保健专业人员提供指导，以便根据成像提供的信息最佳地为患者进行成像和治疗，何时进行治疗以及以何种顺序进行治疗。 © 2023年作者。保留所有权利，由Elsevier B.V.出版。

In prostate cancer (PCa), questions remain on indications for prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging and PSMA radioligand therapy, integration of advanced imaging in nomogram-based decision-making, dosimetry, and development of new theranostic applications.We aimed to critically review developments in molecular hybrid imaging and systemic radioligand therapy, to reach a multidisciplinary consensus on the current state of the art in PCa.The results of a systematic literature search informed a two-round Delphi process with a panel of 28 PCa experts in medical or radiation oncology, urology, radiology, medical physics, and nuclear medicine. The results were discussed and ratified in a consensus meeting.Forty-eight statements were scored on a Likert agreement scale and six as ranking options. Agreement statements were analysed using the RAND appropriateness method. Ranking statements were analysed using weighted summed scores.After two Delphi rounds, there was consensus on 42/48 (87.5%) of the statements. The expert panel recommends PSMA PET to be used for staging the majority of patients with unfavourable intermediate and high risk, and for restaging of suspected recurrent PCa. There was consensus that oligometastatic disease should be defined as up to five metastases, even using advanced imaging modalities. The group agreed that [177Lu]Lu-PSMA should not be administered only after progression to cabazitaxel and that [223Ra]RaCl2 remains a valid therapeutic option in bone-only metastatic castration-resistant PCa. Uncertainty remains on various topics, including the need for concordant findings on both [18F]FDG and PSMA PET prior to [177Lu]Lu-PSMA therapy.There was a high proportion of agreement among a panel of experts on the use of molecular imaging and theranostics in PCa. Although consensus statements cannot replace high-certainty evidence, these can aid in the interpretation and dissemination of best practice from centres of excellence to the wider clinical community.There are situations when dealing with prostate cancer (PCa) where both the doctors who diagnose and track the disease development and response to treatment, and those who give treatments are unsure about what the best course of action is. Examples include what methods they should use to obtain images of the cancer and what to do when the cancer has returned or spread. We reviewed published research studies and provided a summary to a panel of experts in imaging and treating PCa. We also used the research summary to develop a questionnaire whereby we asked the experts to state whether or not they agreed with a list of statements. We used these results to provide guidance to other health care professionals on how best to image men with PCa and what treatments to give, when, and in what order, based on the information the images provide.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.