PSMA-PET/CT Findings in Patients With High-Risk Biochemically Recurrent Prostate Cancer With No Metastatic Disease by...

Area of Science:

• Oncology
• Radiology
• Nuclear Medicine

Background:

• High-risk nonmetastatic hormone-sensitive prostate cancer (HSPC) eligibility for trials like EMBARK relies on conventional imaging.
• Conventional imaging often underdetects metastatic disease compared to advanced techniques like prostate-specific membrane antigen-positron emission tomography (PSMA-PET).

Purpose of the Study:

• To evaluate the staging information provided by PSMA-PET/computed tomography (PSMA-PET/CT).
• To assess PSMA-PET/CT in patients eligible for the EMBARK trial, focusing on those without metastatic disease by conventional imaging.

Main Methods:

• Retrospective cross-sectional study of 182 patients with recurrent prostate cancer after radical prostatectomy or radiotherapy.
• Patients had elevated PSA levels and PSA doubling time ≤9 months, with exclusion of distant metastatic disease on conventional imaging.
• PSMA-PET/CT was used for staging.

Main Results:

• PSMA-PET/CT was positive in 84% of patients overall.
• Distant metastatic disease (M1 stage) was detected in 46% of patients.
• Polymetastatic disease (≥5 lesions) was identified in 24% of patients.

Conclusions:

• Conventional imaging understages high-risk nonmetastatic HSPC, with PSMA-PET/CT revealing metastatic disease in a significant proportion of patients.
• These findings challenge the interpretation of previous studies and highlight the importance of PSMA-PET in patient selection for prostate cancer trials.
• Further research is needed to determine the prognostic value and therapeutic guidance utility of PSMA-PET.