PSMA PET/CT beneficial for prostate cancer staging

A new study suggests that prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) may be a highly beneficial tool for initial staging of high-risk and high-intermediate-risk prostate cancer.

At the AUA annual meeting in Chicago, researchers reported that by adopting this imaging approach, it may be possible to alter treatment plans and provide more precise and appropriate interventions to avoid treatment failure. The authors found that judicious use of PSMA PET/CT can rule in or rule out lesions suspicious on conventional imaging.

“This is a huge advance. After pathology confirmation, I think the standard of care will be changed and this approach will be adopted. It is already adopted in a lot of places. Europe and Australia are ahead of us in this area,” said study investigator Aydin Pooli, MD, a urologic oncology fellow and clinical instructor in urology at the David Geffen School of Medicine at UCLA, working with Robert E. Reiter, MD, and co-authors.

Read: PET use in prostate cancer widens, but questions remain

PSMA is a transmembrane glycoprotein that is primarily expressed in prostate tissue, and it can be radiolabeled with gallium 68 and used as a tracer in nuclear scan imaging. It has been demonstrated that PSMA is highly sensitive for detecting metastasis. Dr. Pooli and his colleagues investigated the concordance of PSMA PET/CT with conventional imaging in the initial staging in treatment-naïve men with prostate cancer. They conducted a prospective, single-institution database study of patients undergoing PSMA PET/CT from 2016 to 2018 (NCT03368547).

The authors included men with intermediate-risk (Gleason score 7 and/or PSA 10-20 ng/mL) and high-intermediate-risk disease (Gleason score ≥8 and/or PSA >20 ng/mL) who underwent PSMA PET/CT within 3 months of conventional imaging (bone scan and/or abdominopelvic imaging). They analyzed the concordance of PSMA PET/CT with conventional imaging for the identification of N+ (pelvic lymph node), M1a+ (extrapelvic lymph nodes), M1b+ (bone metastases), and M1c+ (visceral metastasis) disease. They also examined the association between PSA level and concordance of conventional imaging and PSMA PET/CT.

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