EAU 2017: PSMA at Initial Staging
Dr. Bomanji started his presentation noting that nearly all imaging studies are from the Western world centers, reminding the audience that a significant proportion of the remaining prostate cancer population does not have access to these imaging capabilities. As strongly as Dr. Bomanji feels about the crucial role PSMA-PET plays in detection of recurrence, he feels there is very little role for PSMA-PET in initial staging of prostate cancer. Particularly since a significant number of 5-mm nodes on conventional imaging are positive for metastatic disease and obviate the need for more expensive modalities.
When questioned from the panel moderators (Drs. Tobias Maurer, Lars Budaus and Riccardo Schiavina) regarding the use of PSMA-PET specifically for high-risk patients, Dr. Bomanji stated that by that point the patient has likely already had an MRI and further imaging should be guided accordingly and PSMA-PET is not unreasonable with appropriate clinical indications. Upon further discussion with the panel, Dr. Bomanji and the experts delved further into high risk patients that may have conflicting imaging reports (from CT and/or bone scan and/or MRI) and concluded that for these patients PSMA-PET may also be useful.
As Dr. Bomanji concludes, we are relearning staging and how to best utilize PSMA-PET in the setting of primary staging, specifically for high-risk patients.
Presented by: Jamshed Bomanji, University College London, London, UK
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
at the #EAU17 -March 24-28, 2017- London, England