Further, its utility in identifying PCa goes beyond the diagnosis settings, as it can be used to guide the selection of patients who would benefit from metastatic-directed radiation therapy or PSMA-targeted radioligand therapy. Thus, PSMA PET imaging may result in significant alterations in clinical decision-making, although uncertainty remains regarding whether this improved sensitivity for early detection results in clinically meaningful patient outcomes.
This article reviews the recent literature highlighting the rapid evolution of PSMA PET into the mainstream of staging and restaging and serves as a resource for clinicians and researchers involved in the domains of PCa diagnosis and management.
Written by: Esther Mena, MD, Liza Lindenberg, MD, and Peter L. Choyke, MD
Molecular Imaging Branch. National Cancer Institute, NIH, Bethesda, MD
References:
- Pienta, K.J., et al., A Phase 2/3 Prospective Multicenter Study of the Diagnostic Accuracy of Prostate Specific Membrane Antigen PET/CT with (18)F-DCFPyL in Prostate Cancer Patients (OSPREY). J Urol, 2021. 206(1): p. 52-61.
- Hope, T.A., et al., Diagnostic Accuracy of 68Ga-PSMA-11 PET for Pelvic Nodal Metastasis Detection Prior to Radical Prostatectomy and Pelvic Lymph Node Dissection: A Multicenter Prospective Phase 3 Imaging Trial. JAMA Oncol, 2021. 7(11): p. 1635-1642.
- Morris, M.J., et al., Diagnostic Performance of 18F-DCFPyL-PET/CT in Men with Biochemically Recurrent Prostate Cancer: Results from the CONDOR Phase III, Multicenter Study. Clinical Cancer Research: An Official Journal of the American Association for Cancer Research, 2021. 27(13): p. 3674-3682
- Buteau, J.P., et al., Clinical Trial Protocol for PRIMARY2: A Multicentre, Phase 3, Randomised Controlled Trial Investigating the Additive Diagnostic Value of [(68)Ga]Ga-PSMA-11 Positron Emission Tomography/Computed Tomography in Men with Negative or Equivocal Multiparametric Magnetic Resonance Imaging for the Diagnosis of Clinically Significant Prostate Cancer. Eur Urol Oncol, 2024. 7(3): p. 544-552.
- Seifert, R., et al., Second Version of the Prostate Cancer Molecular Imaging Standardized Evaluation Framework Including Response Evaluation for Clinical Trials (PROMISE V2). Eur Urol, 2023. 83(5): p. 405-412.
- Sartor, O., et al., Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer. N Engl J Med, 2021. 385(12): p. 1091-1103
- Gafita, A., et al., Nomograms to predict outcomes after (177)Lu-PSMA therapy in men with metastatic castration-resistant prostate cancer: an international, multicentre, retrospective study. Lancet Oncol, 2021. 22(8): p. 1115-1125.