To evaluate accuracy and costeffectiveness of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) as single procedure in diagnosing and staging high grade prostate cancer (PCa).
From June 2022 to December 2025, 330 men (median age: 65 years) underwent transperineal prostate biopsy for the suspicion of high grade PCa (PSA >20 ng/ml and/or suspicious digital rectal examination). All the patients underwent PSMA PET/CT targeted biopsy of intraprostatic lesions suspicious for PCa (Standard Uptake Value >8) combined with extended prostate biopsy.
Median PSA was 30.5 ng/ml (range: 20-785 ng/ml) and 135/330 (41%) men had positive DRE; a csPCa was found in 325/330 (98.5%) patients and 297/325 (91.4%) had a Gleason score >8/ISUP Grade Group >4. Clinical staging by PSMA PET/CT demonstrated: 130 (40%) cT2PCa vs 195 (60%) cT3PCa cases; in detail, 95/325 (29.2%) had positive nodes, 60 (18.5%) bone metastases and 40 (12.3%) multiple metastases. The overall reimbursement for diagnosing PCa in the 330 patients submitted to prostate biopsy was 471,883,5 €.; using PSMA PET/CT without MRI the cost of this latter procedure could be spared for a total of 71,016 €.
PSMA PET/CT as a single imaging procedure demonstrated an high accuracy in diagnosing and staging high grade PCa, moreover, improved cost-effectiveness and allowed to start quickly therapy.
Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2026 Mar 03 [Epub ahead of print]
Pietro Pepe, Ludovica Pepe, Gabriele Pepe, Vincenzo Fiorentino
Urology Unit, Cannizzaro Hospital, Catania., Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina., Health Economics and Management - Ministry of Health, Rome.