⁶⁸Ga‐PSMA‐PET/CT staging prior to definitive radiation treatment for prostate cancer

Abstract

PSMA-PET/CT identified the primary in 99% of patients, and altered staging in 21% of men with intermediate or high-risk prostate cancer referred for definitive EBRT compared to CT, bone scan and multiparametric MRI. Following this audit, we recommend the routine use of PSMA-PET/CT prior to EBRT in this patient group.

Risk of metastatic disease on 68gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

“…The negative predictive value of 68 Ga‐PSMA PET/CT for lymph node metastases was 80.8%. This confirms earlier small series studies showing 68 Ga‐PSMA PET/CT provides superior lymph node primary staging to CT in surgery and radiotherapy . On a per‐patient based meta‐analysis of 224 men, the accuracy of 68 Ga‐PSMA PET/CT to detect microscopic lymph node metastasis on PLND was 61% , with larger diameter lymph node metastasis more likely to be identified on 68 Ga‐PSMA PET/CT.…”

Utility of Ga68 prostate‐specific membrane antigen positron‐emission tomography for pre‐operative staging of high‐risk prostate cancer in a prospective cohort

“…A pair of studies examined the management change in definitive radiation therapy based on PSMA findings . Hruby et al included 109 men, with frequent changes to the staging and alterations to the radiotherapy field, including further pelvic nodes, and applying boost doses to specific areas with PSMA avidity. Dewes et al similarly found PSMA led to frequent changes in radiotherapy field in a group of 15 men.…”

“…The development of PSMA PET/MRI may allow the benefits of both modalities simultaneously . However, while there is emerging data on how PSMA impacts clinical practice, there is a paucity of prospective studies showing how these findings influence clinical decision‐making.…”

Comparative study between 68Ga‐prostate‐specific membrane antigen positron emission tomography and conventional imaging in the initial staging of prostate cancer

“…In comparison, Dewes et al . demonstrated a 40% upstage and 13% downstage when 68 Ga‐PSMA PET is integrated in initial staging which resulted in a change in RT management in 33% of patients . In a prospective study conducted by Hruby et al ., the use of 68 Ga‐PSMA PET resulted in a change in stage in 21% of patients, of which only 2.8% of patients were downstaged …”

“…Patients with oligometastatic disease are also most likely to be downstaged. Patients from the intermediate risk group are 22 In a prospective study conducted by Hruby et al, the use of 68 Ga-PSMA PET resulted in a change in stage in 21% of patients, of which only 2.8% of patients were downstaged. 23 Overall, management plans were altered in at least 24 (18%) patients.…”