BACKGROUND - Positron emission tomography (PET) imaging is routinely used in many cancer types, although is not yet a standard modality for prostate carcinoma. Prostate-specific membrane antigen (PSMA) PET is a promising new modality for staging prostate cancer, with recent studies showing potential advantages over traditional computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine bone scan imaging.
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However, the impact of PSMA PET on the decision-making of radiation oncologists and outcomes after radiotherapy is yet to be determined. Our aim was to determine the impact of PSMA PET on a radiation oncologist's clinical practice.
FINDINGS - Patients in a radiation oncology clinic who underwent PSMA PET were prospectively recorded in an electronic oncology record. Patient demographics, outcomes of imaging, and impact on decision-making were evaluated. Fifty-four patients underwent PSMA PET between January and May 2015. The major reasons for undergoing PET included staging before definitive (14. 8 %) or post-prostatectomy (33. 3 %) radiotherapy, and investigation of PSA failures following definitive (16. 7 %) or post-prostatectomy (33. 3 %) radiotherapy. In 46. 3 % of patients PSMA was positive after negative traditional imaging, in 9. 3 % PSMA was positive after equivocal imaging, and in 13. 0 % PSMA was negative after equivocal imaging. PSMA PET changed radiotherapy management in 46. 3 % of cases, and hormone therapy in 33. 3 % of patients, with an overall change in decision-making in 53. 7 % of patients.
CONCLUSIONS - PSMA PET has the potential to significantly alter the decision-making of radiation oncologists, and may become a valuable imaging tool in the future.
Radiation oncology (London, England). 2015 Nov 18*** epublish ***
Thomas P Shakespeare
Department of Radiation Oncology, North Coast Cancer Institute, 345 Pacific Highway, Coffs Harbour, NSW, 2450, Australia.