From the Desk of the Associate Editor: PET imaging of prostate-specific membrane antigen in prostate cancer: current state of the art and future challenges.

Recently, there has been a great deal of interest in prostate specific membrane antigen (PSMA) as a basis for positron emission tomography (PET) imaging of prostate cancer. As recently as a few years ago, there were only handfuls of abstracts on this subject matter at the major international urology conferences.  Over the past couple of years, there has literally been an explosion of clinical abstracts, particularly in the evaluation of Ga68 PSMA PET/CT as a staging tool at diagnosis and in the setting of evaluating biochemical recurrence following primary definitive treatment of localised disease.

To a lesser extent there is also interest in its role in defining the primary tumour and as a tool to monitor clinical response to treatment. 

Rowe and colleagues review the current role of PSMA PET imaging. The currency of this review is highlighted by the fact that the vast majority of the clinical data is derived from clinical experience published within the past 5 years.  It is also clear that the use of Ga68 PSMA ligands is emerging as the predominant manner by which PET imaging studies are undertaken. Whilst this review comprehensively explains how the role of PSMA PET imaging is evolving across a number of areas in the evaluation of prostate cancer, there remains a deficiency of adequate large prospective validation studies. 

In my own urological practice environment in Australia, Ga68 PSMA PET/CT is readily available in most of the major cancer centers and is now commonly being used in clinical practice as a substitute for conventional imaging.  This uptake of PSMA PET/CT imaging has occurred ahead of high level research evidence for its benefit and ahead of any agreed guidance on both indications and how the positive scan findings should influence management. Whilst multiple Australian centers are ‘feeling their way,’ the excitement of having an improved ability to detect metastatic or recurrent disease has also created challenges in the management of disease not previously detectable as well as the challenges of false positive and false negative scan results. The latter occurs sufficiently frequently enough to keep our multidisciplinary team (MDT) meetings well occupied.  Whilst the data is currently haphazard, some clarity in the role of PSMA PET imaging is certain to emerge over the next several years. 

Written by: Henry Woo, MD, Surgery, Sydney Adventist Hospital Clinical School, Professor of Robotic Cancer Surgery, Chris O'Brien LifeHouse.

Read the abstract from the Prostate Cancer and Prostatic Diseases 

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