Variation in PSMA PET Adoption for Prostate Cancer Care

In "Variation in PSMA PET Adoption for Prostate Cancer Care," the panel explores why adoption of PSMA PET still lags in some practice settings despite its clear clinical advantages.

Dr. Ghesani asks whether adoption of PSMA PET varies meaningfully between academic and private practice, or between urban and community settings. Dr. Yonover estimates an 80-20 split, with most clinicians embracing molecular imaging quickly while a smaller group remains anchored to conventional imaging. He attributes some of that resistance to the fact that foundational literature on low- and high-volume metastatic disease predates PSMA PET, leaving definitions that do not map cleanly onto molecular imaging findings. Dr. Mendel describes a similar split in his own referral base, noting he still regularly receives patients told they are non-metastatic based on bone scan and CT alone. He explains that the harder conversation is often not ordering the additional PSMA PET, but persuading patients who were already told they are non-metastatic and treatable that another test is necessary, particularly when they are reluctant to pay for it. Dr. Yonover highlights the visual power of PET imaging for patient counseling, noting that patients accustomed to tracking their PSA values as numbers respond very differently when they can see their disease, or its resolution after treatment, on a scan. Dr. Ghesani notes that his network runs numerous prostate cancer clinical trials that still mandate conventional bone scan and CT alongside PSMA-guided imaging, creating an opportunity for direct side-by-side comparison. He explains that bone scans frequently miss marrow-based lesions that have not yet caused cortical disruption, since these produce no osteoblastic response and therefore remain silent on conventional bone scanning even when clearly PSMA-avid. This closing point reinforces why the panel considers molecular imaging substantially more sensitive than conventional staging tools, particularly early in the disease course before bone lesions have progressed to become detectable by older modalities.

The next episode in this series, "Prostate Cancer Case Review: Biochemical Recurrence and a Rib Lesion," features the panel's first detailed case, a patient whose biochemical recurrence surfaces an indeterminate rib lesion.