Purpose 68Ga-PSMA PET/CT maximum standardised uptake values (SUVmax) correlate with PSA and Gleason score. Total lesion PSMA (PSMATL) is a novel parameter without defined clinical use. We aimed to determine if PSMATL correlated with serum PSA, Gleason score and clinical outcomes. Methodology We retrospectively analysed 200 patients with primary or treatment naive biopsy proven prostate cancer with disease localised to the prostate. PSMATL was defined as the product of PSMA-avid primary tumour volume and SUVmean. Results Median follow up was 40.5 months (25-60) and median PSMATL 29.6 (14.8-54.8). There was a weak correlation between PSMATL and PSA (Spearman ρ=0.334), and a significant difference in mean PSMATL across PSA groups ≤10, 10-20, ≥20. In the radical prostatectomy (RP) subgroup, PSMATL demonstrated a weak correlation with PSA and PSA density (ρ=0.397 and ρ=0.242). In the RP subgroup, there was a weak correlation with PSMATL and RP Grade Group (ρ=0.233), primary tumour stage (ρ=0.244) and lymph node stage (ρ=0.259). A significant difference in mean PSMATL was observed between the presence or absence of seminal vesicle involvement, perineural invasion and lymphovascular invasion. Aside from Grade Group there was no association between SUVmax and any outcome. There was a 1% increased chance of biochemical recurrence (BCR) per unit increase in PSMATL. The median PSMATL in patients with BCR was 35.1 (16.8-61.5) compared to 25.0 (14.5-54.8) in those without. There was no association with SUVmax. Conclusion PSMATL may correlate with PSA, PSA density and Grade Group. There was an association with RP histology and clinical outcomes, which SUVmax did not show. Further studies are needed to assess its role in routine practice.