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PSA Zero Radiographic Disease Progression on PSMA PET/CT.

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Summary
This summary is machine-generated.

Prostate cancer can progress radiographically even with undetectable PSA levels. Advanced imaging like PSMA PET/CT is crucial for early detection and management, regardless of PSA status.

Keywords:
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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiology

Background:

  • Prostate cancer (PCa) progression can occur despite undetectable prostate-specific antigen (PSA) levels.
  • Radiographic disease progression (rDP) in PCa requires further investigation, especially in the context of low PSA.
  • The utility of PSMA PET/CT in identifying rDP with undetectable PSA needs clarification.

Purpose of the Study:

  • To determine the frequency and characteristics of radiographic disease progression (rDP) on PSMA PET/CT in prostate cancer (PCa) patients with undetectable PSA levels.
  • To analyze the clinical implications of PSA zero rDP, including progression to castration-resistant PCa and overall survival.
  • To evaluate the association between sites of rDP and overall survival (OS).

Main Methods:

  • Analysis of the Mayo Clinic PSMA PET Prostate Cancer Registry for patients with rDP and undetectable PSA.
  • Confirmation of disease progression via biopsy or treatment response.
  • Estimation of overall survival (OS) using Kaplan-Meier method and log-rank test for group comparisons.

Main Results:

  • 12% (257/2141) of patients exhibited PSA zero rDP between 2021-2023.
  • 61% had initially localized disease, 39% had de novo metastatic disease.
  • Visceral metastases were significantly associated with poorer OS (p < 0.0001).

Conclusions:

  • Prostate cancer patients frequently develop metastatic disease even with undetectable PSA values.
  • Periodic advanced imaging, such as PSMA PET/CT, is recommended irrespective of PSA levels for timely detection of progression.
  • Early detection through advanced imaging facilitates prompt management of PCa progression.