PSMA PET in Active Surveillance: Initial Experiences and Future Directions

Background/Objectives: We conducted an exploratory review of patients in our institutions who had undergone a PSMA PET/CT whilst on active surveillance, determining patient characteristics and trends. Methods: A retrospective cohort study of patients who were on active surveillance for low or favourable intermediate-risk prostate cancer and had a PSMA PET/CT done due to the presence of risk factors was performed. Risk factors that were an indication for PSMA PET/CT were: The presence of ISUP GG 2 disease, or ISUP GG1 disease with a PSA > 10 or a PI-RADS score of 4 or 5 on their MRI. Results: We identified 45 patients who underwent PSMA PET/CT whilst on active surveillance. Of these patients, 14 remained on active surveillance at the time of review, whilst 31 had progressed to definitive treatment. There was a significantly different distribution of PRIMARY scores between these two groups, although the average SUVMax was similar. In our practice, we found PSMA PET/CT to be particularly useful when performing confirmatory biopsies on patients who had normal MRI scans or were unable to go for the MRI at the time of diagnosis. Conclusions: PSMA PET/CT shows promise as a tool for active surveillance, particularly in men with risk factors for progressing to active treatment. However, our cohort was too small to draw definitive conclusions, and further research is needed.