How Does Routine Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Modify the...

Area of Science:

• Oncology
• Radiology
• Nuclear Medicine

Background:

• Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) and novel treatments are transforming metastatic prostate cancer (PCa) management.
• Implementation of these advancements in clinical practice requires consensus on definitions and imaging strategies.

Purpose of the Study:

• To achieve consensus among Dutch experts on definitions, preferred imaging for staging, and treatment selection for metastatic PCa in the era of advanced imaging.
• To establish guidelines for integrating PSMA-PET/CT into routine PCa care.

Main Methods:

• A modified Delphi method was employed, involving two voting rounds and a face-to-face meeting with 40 Dutch PCa experts.
• Consensus was defined as agreement among ≥75% of panellists; appropriateness was assessed using the RAND/UCLA method.

Main Results:

• Consensus was reached on using PSMA-PET/CT for metastatic screening in unfavorable intermediate- or high-risk PCa.
• PSMA-PET/CT findings were deemed feasible for treatment decisions in synchronous metastatic hormone-sensitive PCa, with a majority favoring treatment intensification or deintensification based on staging changes.
• No agreement was found on the CHAARTED criteria for interpreting metastatic disease volume on PSMA-PET/CT, highlighting uncertainty in specific criteria application.

Conclusions:

• PSMA-PET/CT is the preferred modality for initial PCa staging and is increasingly integrated into treatment planning in the Netherlands.
• While PSMA-PET/CT guides treatment intensification and deintensification, clear criteria for interpreting metastatic disease volume remain uncertain and require further research.