PSMA PET in Active Surveillance: Initial Experiences and Future Directions

Area of Science:

• Oncology
• Nuclear Medicine
• Radiology

Background:

• Active surveillance is a management strategy for low or favorable intermediate-risk prostate cancer.
• Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is an advanced imaging technique.
• The utility of PSMA PET/CT in patients on active surveillance requires further investigation.

Purpose of the Study:

• To explore patient characteristics and trends of individuals undergoing PSMA PET/CT while on active surveillance.
• To determine the role of PSMA PET/CT in risk stratification for prostate cancer progression during active surveillance.

Main Methods:

• Retrospective cohort study of 45 patients with prostate cancer on active surveillance.
• PSMA PET/CT was performed due to specific risk factors (ISUP GG 2, ISUP GG1 with PSA > 10, or PI-RADS 4/5).
• Analysis of patient characteristics, PRIMARY scores, and SUVMax in relation to treatment progression.

Main Results:

• 14 patients remained on active surveillance, while 31 progressed to definitive treatment.
• Significant differences in PRIMARY scores were observed between the groups.
• PSMA PET/CT was found useful for confirmatory biopsies in cases of normal or unavailable MRI.

Conclusions:

• PSMA PET/CT demonstrates potential as a valuable tool in active surveillance for prostate cancer, particularly in patients with risk factors.
• The current study cohort is too small to establish definitive conclusions.
• Further research is warranted to validate the role of PSMA PET/CT in active surveillance management.