Real-World Experience With Prostate-Specific Membrane Antigen-Positron Emission Tomography in Primary Staging and...

Prostate-specific membrane antigen-positron emission tomography (PSMA-PET) is guideline recommended across multiple clinical scenarios, but the real-world adoption and performance characteristics of this novel technology remain underreported.

Patients undergoing PSMA-PET imaging in either primary staging or postprostatectomy settings were reviewed within the Michigan Urological Surgery Improvement Collaborative data registry. Adoption over time and rates of positive findings by location and risk group at diagnosis (staging setting) or PSA level at the time of scan (postprostatectomy setting) were tabulated. Staging PSMA-PET findings were compared with pelvic lymph node dissection yield and characteristics associated with false-negative PSMA-PET were explored.

The study cohort comprised 2433 PSMA-PET scans among 2342 patients. Adoption increased over the study period-up to 46% of high-risk patients underwent staging PSMA-PET by 2024. Positive and negative predictive values for pelvic lymph node pathology were 21.1% and 92.0%, respectively. Patients with positive lymph node pathology despite negative PSMA-PET had higher Gleason grade (P = .034) and pT stage (P < .001) compared with patients with negative imaging and pathology. In total, 58.1% of scans were positive in the postprostatectomy setting, with significant rates of positive imaging findings seen at low PSA values (32% among patients with PSA < 0.2 ng/mL at the time of imaging).

PSMA-PET has seen widespread adoption; real-world performance characteristics show modest divergence from those reported in clinical trials. Further work will more directly assess the impact of this novel imaging modality on patient management.