(UroToday.com) The 2025 GU ASCO annual meeting featured a prostate cancer session and a presentation by Dr. Glenn Bauman discussing a prospective provincial registry of PSMA PET/CT for recurrent prostate cancer. While most prostate cancer is initially localized, about 25% of patients treated with surgery or radiation experience biochemical failure, and traditional imaging struggles to detect sites of these recurrences early. PSMA PET/CT scanning has emerged as a more effective tool for detecting recurring prostate cancer, potentially enabling earlier treatment interventions. PREP was initiated in Ontario to provide access and characterize the performance of PSMA PET CT (18F-DCFPyL PSMA PET-CT) among men with recurrent prostate cancer after primary definitive treatment (radical prostatectomy or radiation therapy).
Between March 2018 and September 2022, 4,135 men were accrued. Men were enrolled and imaged with 18F-DCFPyL at 1 of 6 participating sites within 1 of 6 clinical cohorts. Standardized reports delineated sites of recurrence and post PSMA PET management changes among predefined clinical cohorts. Linkage to provincial databases allowed estimation of overall survival and utilization of salvage radiotherapy after PSMA PET.
The median follow-up for this study was 1.8 years. The median age was 71.0 years (IQR 66.0-76.0), median PSA was 1.3 ng/mL (IQR 0.3-4.0), 29.4% of patients had negative PET findings, 33% had locoregional recurrence on PET, 24.7% had oligometastatic disease, and 12.6% had extensive metastases. Overall, 50.1% of patients had a change in management after their PET scan, 41.8% had radiotherapy within 6 months, and 3.3% of patients died during follow-up. The following figure demonstrates the odds of a positive PSMA PET based on the clinical scenario at presentation and PSA at the time of imaging:
A change in management post PET was a significant predictor of improved survival:
Dr. Bauman concluded his presentation by discussing a prospective provincial registry of PSMA PET CT for recurrent prostate cancer with the following take-home points:
- Higher PSA levels and clinical scenario at the time of imaging predicted positive PET/CT scans with the highest positivity rate for those referred for progression on salvage hormone therapy
- Patients whose treatment plans were changed based on PET results had improved survival
- Future directions include PREP continuing expansion to additional sites in Ontario and adding additional tracers (PSMA 1007 and 68Ga-PSMA)
Presented by: Glenn Bauman, MD, FRCPC, Department of Oncology, Western University, London, Canada
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2025 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, CA, Thurs, Feb 13 – Sat, Feb 15, 2025.