Impact of PSMA PET on Treatment Selection in Advanced Prostate Cancer

In ‘Impact of PSMA PET on Treatment Selection in Advanced Prostate Cancer,’ Dr. Neal Shore delves into the ongoing evolution and variability in interpreting PSMA PET imaging in advanced prostate cancer. As the use of PSMA PET expands, clinicians and imaging specialists are working to establish more standardized approaches to interpretation, including how standardized uptake values (SUVs) are measured, reported, and contextualized. However, considerable variability remains across institutions, countries, and disease states, reflecting differences in clinical experience, reporting frameworks, and patient populations.

The discussion highlights how interpretation can differ depending on disease stage, from biochemical recurrence to metastatic hormone-sensitive and castration-resistant prostate cancer, as well as evolving classifications such as those outlined by the Prostate Cancer Working Group 4. A key challenge lies in reconciling discrepancies between conventional imaging and PSMA PET findings, particularly when PSMA PET identifies a higher burden of disease that was previously undetected. These differences can significantly impact clinical decision-making, including the selection and intensification of systemic therapies, such as doublet versus triplet regimens, and the use of metastasis-directed treatments like radiation therapy.

Dr. Shore also acknowledges the inherent limitations of imaging, including the potential for false positives and false negatives, which further complicates interpretation. As a result, there is a growing emphasis on collaboration with nuclear medicine and radiology specialists to improve reporting consistency and clinical integration. Ultimately, this segment underscores the need for continued refinement of interpretation standards to ensure that PSMA PET findings are applied accurately and effectively in guiding treatment sequencing and overall disease management in advanced prostate cancer.

Out next episode, ‘Clinical Use of PSMA PET in Advanced Prostate Cancer,’ Dr. Shore explores real-world variability in PSMA PET interpretation and use, highlighting differences from clinical trial data. Despite these challenges, PSMA PET remains a critical tool increasingly integrated into advanced prostate cancer care.