# Molecular imaging roadmap: FDG → PSMA → FAP → antigen and immune PET

Source: https://onco.cc/roadmaps/molecular-imaging-roadmap/  
OnCo record `molecular-imaging-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

From a sugar tracer that lights up most cancers to tracers that show a single protein, a stromal cell type, or the immune cells inside a tumour.

## Summary

The molecular imaging roadmap moves from PET scanners and FDG, made routine by PET/CT, to receptor tracers such as 68Ga-DOTATATE and PSMA PET that outperform anatomic imaging and enable theranostics. The current step adds stromal FAPI PET and total-body scanners, and the emerging step brings drug-target and immune PET: TROP2, HER2, B7-H3 and Nectin-4 tracers to select and sequence ADCs, CD8 and granzyme PET to monitor immunotherapy, and PARP PET. The speculative end is multi-tracer same-day imaging, PET-guided adaptive radiotherapy and imaging-derived digital twins. Each new tracer converts a biopsy biomarker into a whole-body map; the route sits in the Imaging section and links PET, PET/CT, FDG PET, PSMA PET, FAPI PET, TROP2 PET, HER2 PET, immuno-PET, PARP PET and PET/MRI.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-04

## Sources

- VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer (New England Journal of Medicine 2021): https://doi.org/10.1056/NEJMoa2107322
- DETECT-A: a blood test plus PET-CT found treatable cancers in 10,000 women with no symptoms (Science 2020): https://doi.org/10.1126/science.abb9601

## Connected records

- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- fronts: [Imaging](https://onco.cc/fronts/imaging/)
- technologies: [AI in radiology](https://onco.cc/technologies/radiology-ai-screening/), [FAPI PET](https://onco.cc/technologies/fapi-pet/), [FDG PET](https://onco.cc/technologies/fdg-pet/), [HER2 PET](https://onco.cc/technologies/her2-pet/), [Immuno-PET](https://onco.cc/technologies/immuno-pet/), [PARP PET](https://onco.cc/technologies/parp-pet/), [PET (positron emission tomography)](https://onco.cc/technologies/pet/), [PET/CT](https://onco.cc/technologies/pet-ct/), [PET/MRI](https://onco.cc/technologies/pet-mri/), [PSMA PET](https://onco.cc/technologies/psma-pet/), [TROP2 PET](https://onco.cc/technologies/trop2-pet/)
- targets: [Somatostatin receptor 2](https://onco.cc/targets/sstr2/)
- companies: [RefleXion Medical](https://onco.cc/companies/reflexion/), [United Imaging](https://onco.cc/companies/united-imaging/)
- drugs: [Piflufolastat F-18 / Pylarify TruVu](https://onco.cc/drugs/pylarify/)
- pairings: [TROP2 PET → TROP2 ADC selection](https://onco.cc/pairings/trop2-pet-to-adc/)

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