Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging has demonstrated potential in addressing prostate cancer (PCa) diagnostic difficulties. According to current guidelines, gallium-68 (⁶⁸Ga)-PSMA-PET is used as an adjunct to traditional imaging modalities in patients with primary PCa. The purpose of this review, conducted using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, is to give an overview of studies that have examined the role of ⁶⁸Ga-PSMA in the initial diagnosis of PCa, its performance in TNM staging, its correlation with prostate-specific antigen (PSA) levels, targeted biopsies, and the International Society of Urological Pathology (ISUP) scores using computed tomography (CT) or magnetic resonance imaging (MRI). The findings demonstrate that, in addition to MRI alone, combining ⁶⁸Ga-PSMA-PET with MRI-targeted biopsy improves the initial identification of clinically significant prostate cancer (csPCa), particularly for ambiguous prostate imaging-reporting and data system (PI-RADS) three lesions. ⁶⁸Ga-PSMA-PET/CT is useful when MRI results for csPCa are uncertain, but consistent techniques are required. Regarding risk assessment and therapy planning, ⁶⁸Ga-PSMA-PET has a strong correlation with both PSA levels and ISUP scores. It accurately detects primary PCa lesions, making it suitable for high-risk patients. In ⁶⁸Ga-PSMA-PET, higher maximum standardized uptake value (SUVmax) readings are linked to more aggressive illness. For N and M staging, ⁶⁸Ga-PSMA-PET/CT is more sensitive and specific than conventional imaging; however, for T-staging, multiparametric MRI (mpMRI) provides better accuracy. ⁶⁸Ga-PSMA-PET/MRI shows improved accuracy for primary PCa detection compared to mpMRI alone. Challenges include the lack of standardized SUVmax cutoff values. ⁶⁸Ga-PSMA-PET is useful for the initial diagnosis and staging of PCa, complementing MRI, although further research is needed to standardize imaging techniques and interpretations.